Granulomatosis with Polyangiitis (Wegner's granulomatosis)
A patient presented to the Bascom Palmer Emergency Room for bilateral eye pain, redness, discharge, and blurry vision for 2 months. He had a history of recently-identified, poorly-controlled hypertension. He denied a past ocular history. He raised pigs for work, and endorsed heavy substance use (cocaine, alcohol, and cannabis). On initial exam his vision was 20/25 in both eyes, and intraocular pressures were normal in both eyes. Anterior segment exam revealed significant injection in the right more than left eye, associated with significant corneal pannus worse in the right than the left. The right cornea also was noted to have a epithelial defect and a few areas of infiltrate near the area of pannus. The rest of the anterior and posterior exam was normal. Further history revealed the patient had been having hematuria and epistaxis for the last several months, initially improving on a short course of steroids, but he quickly relapsed. Given the strong suspicion for possibly life-threatening vasculitis, the patient was admitted for expedited workup, and laboratory testing revealed positive c-ANCA and anti-PR3 antibodies, as well as pulmonary lesions, and significant sinus changes with naso-septal perforation on imaging. The pattern of his systemic manifestations was not thought to be attributable solely to his prior cocaine use. He was started on rituximab and an oral steroid taper with significant improvement in symptoms.
Presentation Date: 10/09/2025
Issue Date: 03/06/2026
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