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. 2015:2015:271823.
doi: 10.1155/2015/271823. Epub 2015 Apr 8.

Granulomatosis with polyangiitis presenting as a choroidal tumor

Taro Masuda  1 , Yasumori Izumi  1 , Hayato Takeshita  1 , Chieko Kawahara  1 , Yoshika Tsuji  1 , Hirokazu Kurohama  2 , Nozomi Iwanaga  1 , Miwako Inamoto  3 , Keiichi Kase  4 , Masahiro Ito  2 , Atsushi Kawakami  5 , Kiyosi Migita  1
Affiliations

Granulomatosis with polyangiitis presenting as a choroidal tumor

Taro Masuda et al. Case Rep Rheumatol. 2015.

Abstract

Granulomatosis with polyangiitis (GPA) sometimes involves the eye orbit; however, choroidal involvements in GPA had been rarely reported. We report a rare case presenting with a choroidal mass in an 83-year-old Japanese woman who presented with left eye pain. Diagnostic biopsy revealed necrotizing vasculitis with infiltrates of inflammatory cells. Diagnosis was localized granulomatosis with polyangiitis. Combined treatments with corticosteroid plus azathioprine resolved the choroidal mass region. Although treatment with corticosteroid and immunosuppressive agents improves the prognosis of the disease, ocular morbidity is still well recognized. Clinicians should consider a differential diagnosis of GPA in patients with inflammatory choroidal tumors.

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Figures

Figure 1
Figure 1
MRI images of the choroidal mass. Diffuse-weighted images (DWI) showed high signal intensity in left interior orbital lesion. T2-weighted image (T2WI) showed the choroidal tumor with low intensity of left eye.
Figure 2
Figure 2
Coronal T2-weighted images showing a left choroidal tumor and space-occupying lesions in left paranasal sinus (arrow) before and 3 weeks after steroid treatment.
Figure 3
Figure 3
Magnetic resonance arteriography (MRA) before corticosteroid therapy shows no finding of cerebral vasculitis.
Figure 4
Figure 4
Histology of the left choroidal tumor showing vasculitis of a small-sized artery. Choroidal tumor biopsy specimens showing necrotizing vasculitis with aggregate of inflammatory cells (hematoxylin and eosin staining).
Figure 5
Figure 5
Histology of paranasal sinus biopsy specimens. Paranasal sinus biopsy specimens showing vasculitis with fibrinoid necrosis and small-size artery obliterated by concentric inflammatory cells with granulomatous inflammation (hematoxylin and eosin staining).
Figure 6
Figure 6
Clinical course of the present case.
See this image and copyright information in PMC

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