How is the upper respiratory tract affected clinically by Granulomatosis with polyangiitis

How is the upper respiratory tract affected clinically by Granulomatosis with polyangiitis?

• Paranasal sinuses —chronic sinusitis is a common presenting manifestation (50%) that ultimately affects 80% of patients. Patients commonly carry Staphylococcus aureus that can lead to infection and is associated with GPA relapses.

• Nasal mucosa —chronic inflammation occurs in approximately 70% of patients, resulting in chronic purulent nasal discharge, epistaxis, mucosal ulcerations, and, less commonly, perforation of the nasal septum and disruption of the supporting cartilage of the nose (saddle-nose deformity) .

• Oral mucosa —chronic inflammation may lead to oral ulcers that may or may not be painful.

• Pharyngeal mucosa —chronic inflammation may lead to obstruction of the Eustachian tube, resulting in acute suppurative otitis media or chronic serous otitis media. Hard palate lesions are atypical for GPA and should prompt the clinician to consider cocaine-induced midline destructive lesions or infiltrative malignancy (e.g., natural killer cell/T-cell lymphoma of the sinuses).

• Laryngeal and tracheal mucosa —chronic inflammation may lead to hoarseness and subglottic stenosis, which may result in stridor and respiratory insufficiency in severe cases.

Pearl: new onset otitis media in an adult should make one consider GPA.

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