Granulomatosis with polyangiitis physical examination

The important physical exam findings are Ulcerations, palpable purpura and subcutaneous nodules in the skin; conjunctivitis, uveitis, sinusitis, purulent exudate from nares,saddle nose deformity, reduced hearing in the head and neck; pleuritic chest pain ans signs of atelectasis in lung examination; and signs of mononeuritis multiplex on neural exam.

• Physical examination of patients with Granulomatosis with polyangiitis is usually remarkable for:^[1][2]

• They usually have normal vital signs until infected.

The skin findings are seen in 14% of patients:^[3]

• Ulcerations
• Palpable purpura
• Subcutaneous nodules

• Scleritis
• Keratitis
• Uveitis
• Conjunctivitis
• Proptosis
• Xanthelasma
• Purulent exudate from the nares
• Sinusitis^[4]
• Saddle nose deformity
• Otitis Media
• Hearing acuity may be reduced^[1]
• Weber test may be abnormal
• Rinne test may be positive
• Gingival hyperplasia or necrotizing gingivitis^[5] can be seen

• Neck examination of patients with granulomatosis with polyangiitis is usually normal.

Examination may show signs of:

• Pleuritic pain
• Atelectasis
• Pleural effusion
• Pulmonary hypertension– bibasilar crackles
• Subglottic stenosis

• Friction rub/ Pericardial rub
• S1
• S2

• Abdominal tenderness may be present^[6]
• Guarding may be present

• Back examination of patients with granulomatosis with polyangiitis is usually normal.

• A pelvic/adnexal mass may be palpated
• Inflamed mucosa

• Patient is usually oriented to persons, place, and time
• Mononeuritis multiplex^[7]– Loss of sensory and motor functions
• Cranial nerve paralysis

• Extremities examination of patients with granulomatosis with polyangiitis is usually normal.