EMERGENCY CASEBOOK
Fulminant Wegener’s granulomatosis presenting as epistaxis
Department of Otorhinolaryngology, Peterborough & Stamford NHS Trust, Peterborough, UK
Correspondence to:
Correspondence to:
Dr A Thapar
Department of Otorhinolaryngology, Edith Cavell Hospital, Peterborough PE3 9GZ, UK; ankurthapar{at}doctors.org.uk
The case of a 63-year-old woman who presented to the emergency department with epistaxis and haemodynamic instability is reported. Subsequent investigation showed renal failure and multiple pulmonary nodules. A positive proteinase 3 antineutrophil cytoplasmic antibody test supported the diagnosis of fulminant Wegener’s granulomatosis, requiring urgent dialysis, plasma exchange and immunosuppression. This is the first report in the emergency literature of Wegener’s granulomatosis presenting as acute epistaxis. Emergency physicians should consider Wegener’s granulomatosis in patients with atypical epistaxis. In patients presenting with clinically severe, active disease early proteinase 3 antineutrophil cytoplasmic antibody testing is recommended.
Abbreviations: PR3 ANCA, proteinase 3 antineutrophil cytoplasmic autoantibody
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