# Severe Granulomatosis With Polyangiitis Treated With Low-Dose Cyclophosphamide, Rituximab, Glucocorticoids, and Plasma Exchange: A Case Report

## TL;DR

A 66-year-old man with severe GPA was successfully treated with a combination of drugs and plasma exchange, highlighting the need for aggressive treatment in multi-organ cases.

## Contribution

This case report presents a successful treatment approach for severe GPA with multi-organ involvement.

## Key findings

- The patient showed improvement after treatment with cyclophosphamide, rituximab, steroids, and plasma exchange.
- GPA can lead to severe complications like acute renal failure requiring hemodialysis.
- Prompt diagnosis and aggressive therapy are crucial for preserving organ function in GPA.

## Abstract

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis that affects blood vessels and presents with vague constitutional symptoms, but more serious manifestations can develop, including pulmonary complications and glomerulonephritis. Currently, there are no definitive treatment guidelines. We present a case of a 66-year-old male with no previous medical history who was admitted for generalized constitutional symptoms for the past month. Imaging of the patient's brain revealed dural enhancement. Bronchoalveolar lavage was done and revealed diffuse alveolar hemorrhage (DAH). A kidney biopsy revealed granulomatosis with polyangiitis. The patient’s hospital course was complicated by acute renal failure and required hemodialysis. Due to the patient's multi-organ involvement, the patient was treated aggressively with cyclophosphamide, rituximab, plasma exchange (PE), and steroids. GPA is a systemic vasculitis that can present with multi-organ involvement. A prompt diagnosis is necessary to initiate treatment and preserve organ function. More research is needed to determine which combination therapies are the best treatment modalities in cases of severe multi-organ system involvement.