Endocrine Abstracts (2013) 32 P315 | DOI: 10.1530/endoabs.32.P315

Wegener's granulomatosis in a patient with vitamin D deficiency

Panagiotis Athanassiou1, Ifigenia Kostoglou-Athanassiou2, Eleni Xanthakou3, Anna Papadaki1 & Dimitra Basdragianni1

1Department of Rheumatology, St Paul’s Hospital, Thessaloniki, Greece; 2Department of Endocrinology, Red Cross Hospital, Athens, Greece; 3Endocrinologist, Athens, Greece.

Wegener’s granulomatosis is characterized by necrotizing granulomatous vasculitis. It occurs initially in a localized form, disseminates in various degrees and particularly involves the respiratory tract and kidneys. It is an ANCA-associated vasculitis, a systemic disease of autoimmune aetiology. Recently vitamin D deficiency has been associated with the development of autoimmunity. The aim was to present a case of Wegener’s granulomatosis in a patient with vitamin D deficiency induced by gastric surgery for the treatment of morbid obesity.

A patient, female aged 47 years, presented with chronic episcleritis, conjunctivitis, retroorbital pain and erythema of the left eye over the course of 2 years. The patient had gastric surgery for the treatment of morbid obesity and had also been subjected to thyroidectomy for the treatment of a thyroid nodule. On clinical examination she had a hemorrhagic rash over the lower extremities and bilateral hearing loss. Laboratory investigations revealed vitamin D deficiency, 25(OH)D3 levels being 11.7 ng/ml (normal levels >30 ng/ml), microscopic hematuria, proteinuria, and positive c-ANCA. Imaging studies revealed the presence of nodules in the lungs and signs of left orbital inflammation. The diagnosis of Wegener’s granulomatosis was made. I.v. methylprednisolone pulse therapy was initiated and vitamin D was administered orally with subsequent sustained improvement.

In conclusion, the case of a patient with Wegener’s granulomatosis and vitamin D deficiency after gastric surgery for morbid obesity is presented. Vitamin D deficiency is known to be associated with the development of systemic autoimmune diseases such as multiple sclerosis and rheumatoid arthritis. Vitamin D deficiency induced by gastric surgery may be implicated in the pathogenesis of a systemic autoimmune disease with ocular manifestations in this patient.

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