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Medvedeva L.M.1, Korolkova N.K.1, Pristupa V.V.1, Katulskaya T.V.2, Medvedeva L.Z.1
Ophthalmic manifestations, the peculiarities of сlinical picture of granulomatosis with polyangiitis
1Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
2Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus

Vestnik VGMU. 2018;17(5):132-136.

Granulomatosis with polyangiitis is primary systemic necrotizing vasculitis of small and medium vessels, characterized by the development of granulomatous inflammation foci. Symptoms of this pathology are so multifaceted that they simulate a large number of diseases, and this, in its turn, greatly complicates the diagnosis process and early detection of granulomatosis with polyangiitis.
In the presented clinical case, a woman (33 years old) with concomitant atypical bilateral lobar pneumonia and purulent angina was given the diagnosis of the generalized form of granulomatosis with polyangiitis. During the course of work-up, sarcoidosis was suspected, but CT scan did not confirm this diagnosis, and thereafter biopsy of the lungs concluded the absence of sarcoidosis, at the same time, marginal keratoconjunctivitis of both eyes was revealed. With systemic therapy, the patient’s condition was stabilized during the next year. In May 2015, unilateral exophthalmos appeared on the right eye for the first time, and CT showed granulomas in the right orbit. Systemic treatment and parabulbar injection of corticosteroids led to periodical reposition of the eyeball back into the orbit. In 2016 she suffered from a right-sided purulent dacryoadenitis. She received periodically systemic treatment with metpreson, but the condition of the eye worsened in September 2017. After the addition of rituximab to the treatment regimen, her general condition and visual functions were stabilized.
Key words: granulomatosis with polyangiitis, vasculitis, antineutrophil cytoplasmic antibodies, unilateral exophthalmos, keratitis, corneal ulcer, dacryoadenitis.


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Information about authors:
Medvedeva L.M. – lecturer of the Chair of Ophthalmology, Vitebsk State Order of Peoples’ Friendship Medical University;
Korolkova N.K. – Candidate of Medical Sciences, associate professor, acting head of the Chair of Ophthalmology, Vitebsk State Order of Peoples’ Friendship Medical University;
Pristupa V.V. – Candidate of Medical Sciences, associate professor of the Chair of Ophthalmology, Vitebsk State Order of Peoples’ Friendship Medical University;
Katulskaya T.V. – ophthalmologist, head of the department of eye microsurgery, Vitebsk Regional Clinical Hospital;
Medvedeva L.Z. – senior lecturer of the Chair of Ophthalmology, Vitebsk State Order of Peoples’ Friendship Medical University.

Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Ophthalmology. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Lyudmila M. Medvedeva.

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