Journal of the National Medical Association

Wegener's Granulomatosis with a Possible Thyroidal Involvement

Wegener's granulomatosis (WG) is an autoimmune disorder characterized by the involvement of many organ systems. In patients with refractory disease, the efficacy of cyclophosphamide, corticosteroids and infliximab has been reported recently. Even in cases with serological response, disease progression has still been observed. Herein, we report a case of WG, most likely accompanied with subacute granulomatous thyroiditis while the patient was on cyclophosphamide, corticosteroid and infliximab therapy. As far as we know, this is the first time that such a copresentation has been observed, suggesting that mechanisms other than T-cell-mediated cytotoxicity may be important in the pathogenesis of granulomatous thyroiditis.

Key words: infliximab * subacute thyroiditis * Wegener's granulomatosis

INTRODUCTION

Wegener's granulomatosis (WG) is a disease that usually cannot be cured by high-dose immunosuppressive therapy.' The effectivity of combination therapy with cyclophosphamide, corticosteroids and infliximab (a blocker of tumor necrosis factor-alpha) in patients with relapsed and refractory WG leading to clinical and serological improvement has been confirmed by several reports before.1-3

Subacute granulomatous thyroiditis is an uncommon and self-limited cause of thyrotoxicosis, presenting with neck pain and tenderness at the thyroidal region. Viral infections or postviral inflammatory processes are claimed to play a role in its pathogenesis.4 Until now, there has been no case reported to have subacute granulomatous thyroiditis associated with WG.

Herein, we present a case of refractory WG in a patient who developed a granulomatous thyroiditis while using the above mentioned combination therapy.

CASE

A 54-year-old man with pulmonary renal syndrome was diagnosed with WG in our center in April 2003. …

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