RHINOLOGICAL MANIFESTATIONS OF WEGENER’S GRANULOMATOSIS IN PAKISTANI PATIENTS

Abstract

Objectives: To assess the rhinological manifestations in Pakistani patients and early diagnosis of Wegener’s Granulomatosis
Design of study: Case Series.
Place and Duration of Study: This study was conducted at ENT Department of CMH Rawalpindi in collaboration with Rheumatology Department of Military Hospital Rawalpindi, Pakistan Institute of Medical Sciences Islamabad and Fauji Foundation Hospital from March 2005 to January 2009.
Patients and Method: In this study twenty adult patients reporting to these hospitals were included according to inclusion criteria. All were c-ANCA positive.Both males and female were included in the study The condition was more common in males than females (male: female, 3:2).
All the patients were followed regularly and c-ANCA titres were used to monitor disease activity in these patients.
Results: A total of twenty patients were included in this study out of which 12 were males and 8 females (male:female, 3:2). The age range at presentation was between 20 to 65 years for both male and female. Rhinological features were present in 16 (80%) of our patients. These patients presented with the symptoms of epistaxis,nasal discharge, nasal obstruction, postnasal drip, anosmia and septal perforation. Three (15%) patients had chronic supporative otitis media. They were initially treated by ENT specialists and an alternative diagnosis was suspected only when they failed to respond to conventional treatment or developed other complaints like haemoptysis, and renal impairment. Nasal biopsy was done in 7 patients. It showed necrotizing vasculitis with evidence of granuloma formation in 04 cases while the rest of cases showed chronic non specific inflammation.
Conclusion: Evaluation of rhinological features have significant role in the early diagnosis of Wegener’s Granulomatosis