We report a case of granulomatosis with polyangiitis (GPA) in a pediatric patient with a history of type 1 diabetes mellitus (T1DM) after a somewhat unusual presentation. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides are a relatively rare entity in the general population, and are even less common amongst the pediatric population. Our patient’s chronic history of vague and systemic symptoms paired with social and environmental stressors contributed to her convoluted picture and late diagnosis. In addition, her T1DM adds an interesting element to her case, begging the question of whether her propensity for autoimmune conditions played a role in the development of this disease. With this case, we hope to increase clinician level of suspicion and promote early diagnosis and treatment for future pediatric patients.

To the Editor, We present the case of an 11-year-old female with a history of type 1 diabetes, hematochezia, and iron deficiency anemia who was admitted for hypoxia following an endoscopy and colonoscopy. Room air saturations were in the low eighties, and she was started on oxygen by nasal cannula. A chest radiograph (Figure 1A) demonstrated findings consistent with viral airway disease, and on a nasal swab, she was positive for rhino/enterovirus but negative for COVID.