Juxta-vertebral Lesions Associated with Granulomatosis with Polyangiitis.

A 73-year-old woman was referred to our hospital for a fever, hoarseness, and progressive renal failure. A renal biopsy showed necrotizing extracapillary pauci-immune glomerulonephritis. A laryngoscopic examination revealed inflammation of the vocal cords. Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) levels were elevated. The patient met the Japanese criteria for the diagnosis of granulomatosis with polyangiitis (GPA). She was treated with high-dose steroids and cyclophosphamide, which resulted in amelioration of the clinical symptoms and improvement of the renal function. Glucocorticoid therapy was gradually tapered, and she developed a fever and back pain with another increase in the MPO-ANCA and C-reactive protein (CRP) levels. Chest computed tomography demonstrated juxta-vertebral lesions that were 18-fluorodeoxyglucose positron emission tomography-positive (Picture A and B, arrows). A histological examination of the juxta-vertebral lesions showed nonspecific signs of inflammation and malignancy, and infectious diseases were ruled out (Picture C). Rituximab therapy improved the juxta-vertebral lesions and reduced the MPO-ANCA and CRP levels (Picture D). Juxta-vertebral lesions associated with GPA have rarely been reported (1,2).

Picture.

The authors state that they have no Conflict of Interest (COI).