Granulomatosis with polyangiitis and facial palsy: Literature review and insight in the autoimmune pathogenesis

Iannella, Giannicola; Greco, Antonio; Granata, Guido; Manno, Alessandra; Pasquariello, Benedetta; Angeletti, Diletta; Didona, Dario; Magliulo, Giuseppe

doi:10.1016/j.autrev.2016.02.005

Cited by 28 publications

(15 citation statements)

References 87 publications

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“…A more complete list is shown in Table 3 . Other diseases with mucous skin involvement should always be excluded [ 77 , 78 ]. Clinically, PNP and PV may share many features, but PNP shows blisters developing from inflammatory papules or macules, while PV usually shows blisters on the erythematous background.…”

Section: Differential Diagnosismentioning

confidence: 99%

Paraneoplastic Pemphigus: Insight into the Autoimmune Pathogenesis, Clinical Features and Therapy

Paolino

Didona

Magliulo

et al. 2017

IJMS

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111

195

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Paraneoplastic pemphigus is a rare autoimmune skin disease that is always associated with a neoplasm. Usually, oral, skin, and mucosal lesions are the earliest manifestations shown by paraneoplastic pemphigus patients. The pathogenesis of paraneoplastic pemphigus is not yet completely understood, although some immunological aspects have been recently clarified. Because of its rarity, several diagnostic criteria have been proposed. Besides, several diagnostic procedures have been used for the diagnosis, including indirect immunofluorescence, direct immunofluorescence, and ELISA. We reviewed the most recent literature, searching on PubMed “paraneoplastic pemphigus”. We included also papers in French, German, and Spanish. We found 613 papers for “paraneoplastic pemphigus”. Among them, 169 were review papers. Because of its varying clinical features, paraneoplastic pemphigus still represents a challenge for clinicians. Furthermore, diagnosis and management of paraneoplastic pemphigus requires close collaboration between physicians, including dermatologist, oncologist, and otorhinolaryngologist.

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Section: Differential Diagnosismentioning

confidence: 99%

Paraneoplastic Pemphigus: Insight into the Autoimmune Pathogenesis, Clinical Features and Therapy

Paolino

Didona

Magliulo

et al. 2017

IJMS

Self Cite

111

195

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“…In addition to Bell's palsy, the differential diagnosis of patients who present with an acquired unilateral facial neuropathy includes Lyme disease, human immunodeficiency virus (HIV), sarcoidosis, granulomatosis with polyangiitis (formerly called Wegener's granulomatosis), tuberculous meningitis, Sjögren's syndrome, and vasculitic neuropathy. [33][34][35][36][37] Patients with recurrent ipsilateral facial neuropathy should raise suspicion for neoplastic 19 lithium, 20 phenytoin, 21 etc.) Vitamin B1, B6, B12, E, copper deficiency 18 Vitamin B6 toxicity 18 Paraproteinemia-related neuropathies (MGUS, multiple myeloma, Waldenstrom's macroglobulinemia, POEMS) 22,23 Connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, systemic sclerosis, or scleroderma) 24 Infectious (Lyme, 25 HIV, 26 leprosy, 27…”

Section: A Stepwise Approachmentioning

confidence: 99%

A Clinician's Approach to Peripheral Neuropathy

Siao

Kaku

2019

Semin Neurol

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Peripheral neuropathies are a group of disorders that affect the peripheral nervous system, for which hundreds of etiologies have been identified. This article presents a stepwise approach to the evaluation and workup of peripheral neuropathy, which starts with a detailed history of symptoms, family and occupational history, and a neurological as well as general physical exam. Pattern recognition of various neuropathies can help to build a differential diagnosis based on the presentation. Such patterns include acute versus chronic, primary demyelinating versus axonal, hereditary versus acquired, asymmetric versus symmetric, presence of facial palsies, sensory or motor predominant, and presence of prominent autonomic symptoms. Early categorization of the type of neuropathy can help focus the workup for peripheral neuropathy. Nerve conduction studies and electromyography (NCS/EMG) is the primary diagnostic tool in the evaluation of patients with large-fiber polyneuropathy. One of the most important roles of NCS/EMG is to help categorize polyneuropathy as primary axonal versus primary demyelinating. The finding of a primary demyelinating polyneuropathy narrows the differential diagnosis of polyneuropathy dramatically and increases the chances of finding a treatable etiology. Laboratory workup includes serum studies and potentially cerebrospinal fluid, genetic studies, immunological markers, and fat pad biopsy for select patients. Skin biopsy may be used to assess intraepidermal nerve fiber density if small-fiber neuropathy is suspected, and nerve biopsy may be useful in select cases. In recent years, magnetic resonance imaging and neuromuscular ultrasound have also shown promise in the evaluation of peripheral neuropathy. Identification of the etiology of neuropathy is crucial and often time-sensitive, as an increasing number of causes are now reversible or treatable.

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“…The presenting symptom in our patient was a bilateral facial palsy. By itself, this is an extremely rare finding [6] which unlike the unilateral presentation is seldom secondary to Bell's palsy. It occurs in 1 per 5,000,000 population and warrants a diagnostic work up because most of its causes are systemic diseases, some of which are life-threatening [7].…”

Section: Discussionmentioning

confidence: 83%

Look granulomatosis with polyangiitis (GPA) straight in the face: missed opportunities leading to a delayed diagnosis

Rolle

Muruganandam

Jan

et al. 2019

Autoimmun Highlights

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Granulomatosis with polyangiitis (GPA) is a systemic vasculitis with a potential to involve any organ system. It remains an important cause of kidney related morbidity and mortality. Early diagnosis can be difficult and requires high index of suspicion in all patients, but especially in cases with atypical presentation. We report a case with GPA, which was diagnosed only after new and advancing symptoms belied the original diagnosis of bilateral facial palsy and aortic mural thrombus. which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Granulomatosis with polyangiitis and facial palsy: Literature review and insight in the autoimmune pathogenesis

Cited by 28 publications

References 87 publications

Paraneoplastic Pemphigus: Insight into the Autoimmune Pathogenesis, Clinical Features and Therapy

Paraneoplastic Pemphigus: Insight into the Autoimmune Pathogenesis, Clinical Features and Therapy

A Clinician's Approach to Peripheral Neuropathy

Look granulomatosis with polyangiitis (GPA) straight in the face: missed opportunities leading to a delayed diagnosis

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