Orbitonasal Granulomatosis with Polyangiitis in the Postpartum Period: A Mimicking Presentation
Keywords:
granulomatosis with polyangiitis; orbitonasal involvement; postpartum; c-ANCA/PR3; certolizumab pegol; mimicking orbital diseaseAbstract
Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, may present with orbitonasal inflammation mimicking more common disorders, delaying diagnosis. The aim was to analyze the diagnostic challenges of orbitonasal GPA in the postpartum period, its clinical and imaging integration in the absence of biopsy, and the relevance of a multidisciplinary approach. We report a postpartum woman with rheumatoid arthritis in remission who developed unilateral proptosis, retrobulbar pain, and chronic sinonasal symptoms. Magnetic resonance imaging and computed tomography revealed orbitonasal inflammation without a focal mass, and serology showed positive antineutrophil cytoplasmic antibodies against proteinase 3 (c-ANCA/PR3). Because biopsy was not feasible, the diagnosis was established through clinical, imaging, and immunologic correlation. The disease became evident after certolizumab pegol withdrawal in the postpartum period, leading to diagnostic reclassification. The patient showed clinical improvement with systemic corticosteroids and rituximab, and no orbital progression. This case highlights the need for multidisciplinary assessment to distinguish GPA from thyroid eye disease, infection, or idiopathic inflammation, particularly in physiologically complex contexts such as the postpartum period.
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