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dc.contributor.authorvon Itzstein, Mitchell S
dc.contributor.authorAbeykoon, Jithma P
dc.contributor.authorSummerfield, Daniel D
dc.contributor.authorWhitaker, Jennifer A
dc.description.abstractSkull base osteomyelitis in the setting of granulomatosis with polyangiitis (GPA) is rare and entails significant diagnostic challenges. We present a case of a 65-year-old Caucasian man with a history of rheumatoid arthritis, off immunosuppression for 18 months, who presented with 2 years of chronic headaches, severe fatigue, saddle nose deformity and 20-kilogram unintentional weight loss. Maxillofacial CT revealed an extensive destructive sinonasal and erosive skull base process. Laboratory evaluation showed equivocal elevation of antiproteinase 3 antibodies with negative antineutrophil cytoplasmic antibody panel. Biopsy of the skull base/clivus revealed necrotising granulomatous inflammation with focal vasculitis consistent with GPA, and multiple bone cultures were positive for Pseudomonas aeruginosa. This patient was diagnosed concurrently with GPA and P. aeruginosa skull base osteomyelitis. He was started on a 6-week course of cefepime intravenously and oral prednisone, with the plan to initiate rituximab infusion 2 weeks after initiation of antibiotic therapy.
dc.publisherBMJ Publishing Group
dc.publisher.placeUnited Kingdom
dc.relation.ispartofjournalBMJ Case Reports
dc.subject.fieldofresearchClinical sciences
dc.subject.fieldofresearchClinical sciences not elsewhere classified
dc.subject.keywordsbone and joint infections
dc.titleSevere destructive nasopharyngeal granulomatosis with polyangiitis with superimposed skull base Pseudomonas aeruginosa osteomyelitis
dc.typeJournal article
dc.type.descriptionC2 - Articles (Other)
dcterms.bibliographicCitationvon Itzstein, M; Abeykoon, J; Summerfield, DD; Whitaker, JA, Severe destructive nasopharyngeal granulomatosis with polyangiitis with superimposed skull base Pseudomonas aeruginosa osteomyelitis, BMJ Case Reports, 2017, 2017
gro.hasfulltextNo Full Text
gro.griffith.authorVon Itzstein, Mitchell S.

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