Combined involvement of CNS and pituitary gland as a primary manifestation of Wegener’s granulomatosis
Špíšek R.1, Kolouchová E.2, Jenšovský J.3, Rusina R.4, Plas J.5, Bartůňková J.1
1Ústav imunologie, Univerzita Karlova, 2lékařská fakulta a Fakultní nemocnice Motol, Praha 2Alergologická a imunologická ambulance, Benešov 3Odd. klinické endokrinologie a Osteocentrum, Ústřední vojenská nemocnice, Praha-Střešovice 4Neurologická klinika, Fakultní Thomayerova nemocnice, Praha-Krč 5Neurochirurgická klinika UK 1. LF, Ústřední vojenská nemocnice, Praha-Střešovice |
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Summary:
Wegener granulomatosis is a systemic vasculitis of small and medium vessels. It predominantly
affects upper and/or lower respiratory airways and kidneys and its pathogenesis is not fully
understood. WG relatively frequently affects the nervous system (in 30-50% according to the different
studies). The most frequently it manifests as necrotizing vasculitis that leads to the peripheral
neuropathies or to the cranial nerves palsy. Impairment of the central nervous system is
less frequent and occurs in 2-8 % of patients. Three major pathogenetic mechanisms are described:
CNS vasculitis, spreading of granulomas from the adjacent anatomical areas (paranasal cavities,
orbit etc.) and new formation of granulomas in brain tissue. This case report describes patient,
in whom WG manifested in the form of localized skin involvement and combined CNS involvement
which included pituitary gland. Atypical presentation of WG impedes and slows down the
process of diagnosis and emphasises the need for collaboration between medical specialists.
Key words:
Wegener granulomatosis, case report, diabetes insipidus, panhypopituitarism, CNS
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