# Diagnosis of Granulomatosis With Polyangiitis in a 39‐Year‐Old Woman With a Recent History of Traveling to Malaria‐Endemic Region: A Case Report

## TL;DR

A 39-year-old woman with a complex medical history was diagnosed with Granulomatosis with Polyangiitis after initial suspicion of an infection.

## Contribution

This case report highlights the diagnostic challenges of GPA in patients with multiple comorbidities and recent travel to a malaria-endemic region.

## Key findings

- Initial investigations suggested an infectious etiology, but tests for malaria and other infections were negative.
- Rheumatologic tests confirmed an autoimmune disease, leading to treatment with corticosteroids and immunosuppressants.
- The patient's symptoms improved following treatment, emphasizing the need for a systematic differential diagnosis in complex cases.

## Abstract

Granulomatosis with Polyangiitis (GPA) is a rare vasculitis that can complicate the diagnostic process, especially in patients with complex medical histories. This case report details a 39‐year‐old woman with situs inversus totalis, Kartagener syndrome, and hypothyroidism, who presented to the emergency department with intermittent petechiae, purpura in the lower limbs, and fever following a trip to a malaria‐endemic region. Initial investigations suggested an infectious etiology, but extensive testing for malaria and other infections returned negative results. A transition to autoimmune disease assessment was prompted by the positive results of rheumatologic tests. Pulse doses of Methylprednisolone Sodium Succinate and Rituximab were initiated, and the treatment was continued with Prednisolone, Azathioprine, and Calcium D tablets. The patient's signs and symptoms have improved after this treatment. This case underscores the necessity of considering a comprehensive differential diagnosis and advocating for a meticulous and systematic approach in complex clinical presentations.