Which physical findings are characteristic of granulomatosis?

Updated: Oct 09, 2019
  • Author: Christopher L Tracy, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Sinusitis and disease in the nasal mucosa are the most common findings. Ocular findings include scleritis, episcleritis, keratitis, uveitis, and conjunctivitis. Proptosis may signal a retrobulbar granulomatous mass. Xanthelasma has also been reported.

Otitis media and/or hearing loss may be present. Purulent or serosanguinous nasal discharge may be seen. Saddle nose deformity may be present. (See image below.)

Saddle nose deformity in a 26-year-old man with gr Saddle nose deformity in a 26-year-old man with granulomatosis with polyangiitis. Image courtesy of P. Papadopoulos, MD.

Oral involvement is rare; however, a classic presentation includes "strawberry gingival hyperplasia."

Pulmonary/respiratory signs/symptoms

Pulmonary/respiratory symptoms can include the following:

  • Atelectasis - May be present, with examination findings of dullness on percussion, decreased breath sounds, and crackles on auscultation

  • Lower respiratory tract involvement - May also produce signs of pulmonary consolidation and/or pleural effusion

  • Tracheobronchial disease - May manifest as hoarseness, cough, dyspnea, stridor, and wheezing

  • Subglottic or tracheal stenosis – May also manifest as stridor; stenosis may prove fatal if untreated

  • Hemoptysis - may result from cavitated pulmonary parenchymal lesions, DAH, or bronchiectasis

Cutaneous findings

Cutaneous findings are variable and nonspecific and usually affect the lower extremities. Palpable purpura, papules, subcutaneous nodules, and ulcerations are the most common findings. Ulcerations may resemble pyoderma gangrenosum.

Petechiae, vesicles, pustules, hemorrhagic bullae, livedo reticularis, digital necrosis, subungual splinter hemorrhages, and genital ulcers resembling squamous cell carcinoma have been reported.

Several necrotic, purpuric, and blistering papules Several necrotic, purpuric, and blistering papules and plaques on the hands in a patient with granulomatosis with polyangiitis.

Additional findings

Other symptoms may include the following:

  • General - Patients may be febrile and appear ill

  • Cardiac - Pericardial rub may occur with pericarditis

  • Gastrointestinal - Abdominal pain may be present with splanchnic vasculitis

  • Musculoskeletal - Large- and medium-joint arthritis; polyarticular, symmetrical small- and medium-joint arthralgias; and myalgias may be appreciated

  • Neurologic - Examination of the nervous system may confirm a pattern of mononeuritis multiplex, polyneuropathy, or cranial nerve paralysis


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