# A male patient with proptosis and palatal perforation: A diagnostic challenge

## TL;DR

A 59-year-old man with proptosis and palatal perforation was diagnosed with a rare form of vasculitis after a complex diagnostic journey.

## Contribution

The paper highlights a rare clinical presentation of granulomatosis with polyangiitis involving proptosis and palatal perforation.

## Key findings

- The patient's symptoms included chronic eye issues and nasal obstruction, leading to surgical intervention.
- A biopsy confirmed necrotizing vasculitis with fibrinoid necrosis, supporting a diagnosis of granulomatosis with polyangiitis.
- CT imaging revealed an orbital mass and palatal perforation, key diagnostic clues for the condition.

## Abstract

Granulomatosis with polyangiitis (Wegener's granulomatosis), affects many systems and can show up in a variety of ways. Sometimes, only a few organs are affected. Rare complications of this vasculitis syndrome include a retroorbital pseudotumor with proptosis due to chronic tissue inflammation, as well as necrosis with subsequent palate perforation. We present a 59-year-old male who had multiple ophthalmologic evaluations for chronic pain, redness, and proptosis in the right eye. During the workup for eye problems, he underwent surgery for chronic right nasal obstruction and bloody discharge. After 2 weeks, he noticed pain and ulceration in his hard palate that rapidly transformed into a perforation of the palate and was finally referred to a rheumatologist due to increased erythrocyte sedimentation rate. A CT scan was requested for the patient, which showed an orbital mass and palatal perforation. A biopsy of the mass behind the eye showed that it was inflamed across the membrane and had fibrinoid necrosis, which is a sign of necrotizing vasculitis.