A patient has crusting, epistaxis, septal perforation, pulmonary nodules and glomerulonephritis. Biopsy shows necrotising granulomatous inflammation. What is the most appropriate treatment principle?
This is systemic organ-threatening granulomatosis with polyangiitis. Immunosuppression treats the vasculitis, while ENT intervention is reserved for airway threat, complications and later reconstruction after disease control.
A. Septorhinoplasty during active inflammation: Reconstruction during uncontrolled disease has a high failure risk.
B. Topical saline as sole treatment: Local care cannot control renal and pulmonary vasculitis.
C. Urgent rheumatology-led remission induction while addressing local airway and infection risks: This is systemic organ-threatening granulomatosis with polyangiitis. Immunosuppression treats the vasculitis, while ENT intervention is reserved for airway threat, complications and later reconstruction after disease control.
D. Long-term antibiotics without immunosuppression: Infection may coexist, but does not explain the systemic granulomatous disease.
E. Immediate total rhinectomy: This is destructive and does not treat systemic disease.
If isolated septal damage occurred with cocaine exposure and atypical serology, a cocaine-induced destructive process would require consideration.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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