A rare disease in the differential diagnosis of Multiple Sclerosis (MS): Granulomatosis with Polyangiitis- (GPA) (Wegener Granulomatosis)

Yıl 2021, Cilt: 35 Sayı: 3, 427 - 432, 30.12.2021

Alper Ayaşlı

Öz

A rare disease in the differential diagnosis of Multiple Sclerosis (MS): Granulomatosis with Polyangiitis- (GPA) (Wegener Granulomatosis)

Öz

Granulomatosis with polyangiitis (GPA), Wegener's Granulomatosis (WG), is a systemic inflammatory disease of unknown etiology, with small and medium arteries involvement, characterized by necrotizing granulomatosis. In this article, we present a patient who was referred to our Multiple Sclerosis ( MS) outpatient clinic due to the results of MRI scans suspicion of MS, however was diagnosed as GPA with the peripheral and central nervous systems involvement as a result of the examination. 39-year-old female had visual impairment, hearing loss, and weakness in her right arm and leg. In her history, she had shortness of breath and complaints of painful urination and bloody urine. Her visual acutiy was both 0.4. In the muscle strength examination, right upper extremity was 3/5 and right lower extremity was 2/5. There was hypoesthesia in the right extremity. Biochemistry values were normal. She had diffuse purpuritic lesions of the lower extremity. On cranial MRI, in non-specific T2-FLAIR hyperintense foci settled in white matter and the right optic nerve was evaluated to have a slight kink. Multiple Sclerosis (MS) is an autoimmune central nervous system (CNS) disease characterized with inflammation, demyelination and axon damage. MS is diagnosed according to McDonald’s Criteria that revised in 2017. A lot of disase-disease- are in the differential diagnosis of MS. GPA may affect peripheral and central nervous systems in varying proportions (10%-45%). Although GPA is with atypical onset especially involvement of central nervous system is rarely seen, it takes part in the differential diagnosis of MS.
Keywords: A Rare Disease, Differential Diagnosis of Multiple Sclerosis, Granulomatosis with Polyangiitis, Rheumatological Diseases with Atypical Course

Anahtar Kelimeler

A Rare Disease, Differential Diagnosis of Multiple Sclerosis, Granulomatosis with Polyangiitis, Rheumatological Diseases with Atypical Course

Kaynakça

• Solomon AJ. Diagnosis, Differential Diagnosis, and Misdiagnosis of Multiple Sclerosis. Continuum (Minneap Minn). 2019 Jun;25(3):611-635. PMID: 31162308.
• 2. Wildner P, Stasiołek M, Matysiak M. Differential diagnosis of multiple sclerosis and other inflammatory CNS diseases. Mult Scler Relat Disord. 2020 Jan;37:101452. PMID: 31670010.
• 3. Kamińska J, Koper OM, Piechal K, Kemona H. Multiple sclerosis - etiology and diagnostic potential. Postepy Hig Med Dosw (Online). 2017 Jun 30;71(0):551-563. PMID: 28665284.
• 4. Davatchi F. Behçet's disease. Int J Rheum Dis. 2018 Dec;21(12):2057-2058. PMID: 30681276.
• 5. Uygunoğlu U, Siva A. Behçet's Syndrome and Nervous System Involvement. Curr Neurol Neurosci Rep. 2018 May 23;18(7):35.
• 6. Sauma J, Rivera D, Wu A, Donate-Lopez J, Gallego-