Prostate involvement in granulomatosis with polyangiitis
- 66 Downloads
To present a case of prostate involvement (PI) in granulomatosis polyangiitis (GPA) and analyse related published reports. We employed the following keywords for retrieving reports indexed by MEDLINE/PubMed and/or Scopus: “granulomatosis with polyangiitis”, “Wegener granulomatosis” and “prostate involvement”. Additional searches were performed through Google Scholar and HINARI. All cases that fulfilled the American College of Rheumatology criteria for GPA, standards of Chapel Hill Consensus Conference, and did not match with exclusion criteria were analysed and summarised. A 35-year-old man presented with complaints of stuffy nose, difficulty breathing through the nose, swelling and pain in the left half of the nose, low-grade fever, and discomfort. The nasal mucosal biopsy did not reveal any specific changes. During the inpatient treatment, he developed eye redness, tearing, dysuria, and decreased urinary stream. Prostate-specific antigen (PSA) was elevated (2.81 μg/L; normal values ≤ 1.4 μg/L for males below 40 years). Prostate biopsy findings were consistent with diagnosis of GPA, which was confirmed by detecting elevated anti-PR3 antibodies (4.1 IU; normal values < 1.0 IU). We analysed our case in view of the clinical course of 45 published cases of PI in GPA. PI in GPA is a rare clinical manifestation of the vasculitis. Patients with atypical clinical symptoms of GPA are at risk of delayed diagnosis. The awareness of variable clinical presentations of GPA, particularly specific affection of the prostate gland, is crucial for timely diagnosis.
KeywordsGranulomatosis with polyangiitis Prostate Urogenital system Urological manifestations
RY supervised the patient management, interpreted the obtained data, and edited manuscript. OZ manuscript writing and revision, took part in the consultations for the reported case. MB performed pathomorphological examination, interpreted the data, and revised the manuscript. BD collected data and wrote the initial version of the manuscript, took part in the consultations for the reported case. VH took part in the patient management and manuscript writing. All authors approved the final manuscript for publication.
No funding was received for this study.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from the patient reported in the study.
- 2.Tsiodras S, Poulakou G, Leventakos K, Panopoulou H, Elezoglou A, Manoloudaki K, Panayiotides IG (2016) ‘Prostate abscess’ as the initial manifestation of granulomatosis with polyangiitis (Wegener’s granulomatosis). Urol Int 96(2):244–246Google Scholar
- 3.Watts RA, Mahr A, Mohammad AJ, Gatenby P, Basu N, Flores-Suarez LF (2015) Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis. Nephrol Dial Transplant 30(1):14–22Google Scholar
- 4.Comarmond C, Cacoub P (2014) Granulomatosis with polyangiitis (Wegener): clinical aspects and treatment. Autoimmun Rev 13(11):1121–1125Google Scholar
- 6.Alba MA, Moreno-Palacios J, Beça S, Cid MC (2015) Urologic and male genital manifestations of granulomatosis with polyangiitis. Autoimmun Rev 14(10):897–902Google Scholar
- 7.Huong DL, Papo T, Piette JC, Wechsler B, Bletry O, Richard F, Godeau P (1995) Urogenital manifestations of Wegener granulomatosis. Medicine 74(3):152–161Google Scholar
- 9.Leavitt RY, Fauci AS, Bloch DA, Michel BA, Hunder GG, Arend WP et al (1990) The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 33:1101–1107Google Scholar
- 10.Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F et al (2013) 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65:1–11Google Scholar
- 11.Middleton G, Karp D, Lee E, Cush J (1994) Wegener’s granulomatosis presenting as lower back pain with prostatitis and ureteral obstruction. J Rheumatol 21(3):566–569Google Scholar
- 12.Bansal N, Duggal L, Jain N, Jain S, Sharma A, Arora N (2017) Prostate involvement in granulomatosis with polyangiitis: a rarity. Int J Rheum Dis 20(11):1841–1842Google Scholar
- 13.Bray VJ, Hasbargen JA (1991) Prostatic involvement in Wegener’s granulomatosis. AJKD 17(5):578–580Google Scholar
- 14.Brunner A, Tzankov A, Akkad T, Lhotta K, Bartsch G, Mikuz G (2004) Wegener’s granulomatosis presenting with gross hematuria due to prostatitis. Virchows Arch 444(1):92–94Google Scholar
- 15.Chan J, Braun M, Elzawawy H, Berho M, Kirsch J (2012) Granulomatosis with polyangiitis presenting as prostatitis: an uncommon scenario. WJNU 1(2–3):94–97Google Scholar
- 16.Davenport A, Downey SE, Goel S, Maciver AG (1996) Wegener’s granulomatosis involving the urogenital tract. Br J Urol 78(3):354–357Google Scholar
- 17.Dufour JF, Le Gallou T, Cordier JF, Aumaître O, Pinède L, Aslangul E, Dubois A (2012) Urogenital manifestations in Wegener granulomatosis: a study of 11 cases and review of the literature. Medicine 91(2):67–74Google Scholar
- 18.Gaber KA, Ryley NG, MacDermott JP, Goldman JM (2005) Wegener’s granulomatosis involving prostate. Urol 66(1):15Google Scholar
- 19.Gunnarsson R, Omdal R, Kjellevold KH, Ellingsen CL (2004) Wegener’s granulomatosis of the prostate gland. Rheumatol Int 24(2):120–122Google Scholar
- 20.Heldmann F, Brandt J, Schoppe H, Braun J (2006) A 46-year-old-patient with granulomatous prostatitis, arthralgia and haemorrhagic rhinitis. Dtsch Med Wochenschr 131(1–2):22–25Google Scholar
- 21.Khattak AQ, Nair M, Haqqani MT, Williamson EP (1999) Wegener’s granulomatosis: prostatic involvement and recurrent urinary tract infections. BJU Int 84(4):531–532Google Scholar
- 22.Murty GE, Powell PH (1991) Wegener’s granulomatosis presenting as prostatitis. Br J Urol 63:107–108Google Scholar
- 23.Navarro D, Pusey C (2018) Prostate involvement in granulomatosis with polyangiitis: response to rituximab treatment. Port J Nephrol Hypertens 32(1):75–77Google Scholar
- 24.Sözer IT (1986) Wegener’s granulomatosis with infiltration of the prostate. Br J Urol 58(2–4):335Google Scholar
- 25.Stillwell TJ, DeRemee RA, McDonald TJ, Weiland LH, Engen DE (1987) Prostatic involvement in Wegener’s granulomatosis. J Urol 138(5):1251–1253Google Scholar
- 26.Suryaprakash V, Murthy P, Liza R, Ramreddy Ch, Srinivas N, Prayag A (2006) Wegener’s granulomatosis of urinary tract presenting as bladder outlet obstruction. Indian J Urol 22:264–265Google Scholar
- 28.Tung KT, Woolf A, Falzon M (1987) Prostatic involvement in Wegener’s granulomatosis. Postgrad Med J 63(735):53–54Google Scholar
- 29.Vaught WW, Wilson TM, Raife MJ, Horne DW (1989) Wegener granulomatosis: prostatic involvement and bladder outlet obstruction. Urol 34(1):43–45Google Scholar
- 30.Yalowitz PA, Greene LF, Sheps SG, Carlin MR (1966) Wegener’s granulomatosis involving the prostate gland: report of a case. J Urol 96:801–804Google Scholar
- 32.Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD et al (1992) Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med 116:488–498Google Scholar
- 33.Holle JU, Gross WL, Holl-Ulrich K, Ambrosch P, Noelle B, Both M et al (2006) Prospective long-term follow-up of patients with localised Wegener’s granulomatosis: does it occur as persistent disease stage? Ann Rheum Dis 69:1934–1939Google Scholar
- 34.Sinico RA, Di Toma L, Radice A (2013) Renal involvement in anti-neutrophil cytoplasmic autoantibody associated vasculitis. Autoimmun Rev 12(4):477–482Google Scholar
- 35.Salama AD, Little MA (2012) Animal models of antineutrophil cytoplasm antibody-associated vasculitis. Curr Opin Rheumatol 24:1–7Google Scholar
- 36.Kallenberg CG (2015) Pathogenesis and treatment of ANCA-associated vasculitides. Clin Exp Rheumatol 33(4 Suppl 92):11–14Google Scholar
- 37.Ono N, Niiro H, Ueda A, Sawabe T, Nishizaka H, Furugo I, Tada Y (2015) Characteristics of MPO-ANCA-positive granulomatosis with polyangiitis: a retrospective multi-center study in Japan. Rheumatol Int 35(3):555–559Google Scholar