Cause Analysis of One Long-Term Misdiagnosed Patient with Necrotizing Granulomatous Vasculitis

Objective To improve the awareness of necrotizing granulomatous vasculitis(NGV) in order to reduce the misdiagnosis and missed diagnosis rates.Methods Clinical data of 1 patient with NGV in our hospital misdiagnosed for ten years were retrospectively analyzed.Results A 48-year-old female was misdiagnosed as having chronic glomerulonephritis because of hypertension and proteinuria 10 years ago,but the treatment results were not satisfactory.The patient was found having nasal sinusitis 4 years ago;she was diagnosed as having autoimmune hepatitis because of xanthochromia,nausea and vomiting by liver biopsy 2 years ago.She complained for cough and fever this time,chest CT showed bilateral multiple pulmonary nodules,then she was diagnosed as having pneumonia.A variety of antibiotic therapies failed.She was finally diagnosed as having NGV by open lung biopsy.The patient's symptoms obviously improved by glucocorticoids and cyclophosphamide treatment.Conclusion NGV is often involved with multiple system,and shows a mono-system of disease such as glomerulonephritis,nasal sinusitis and hepatitis during the early period.It tends to be easily misdiagnosed or missed diagnosed.Clinicians should enhance awareness of this disease.