Episode 211: Granulomatosis with Polyangiitis

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Granulomatosis with Polyangiitis (GPA) (Core EM Podcast, Episode 211)
Podcast page: https://coreem.net/podcast/episode-211-granulomatosis-with-polyangiitis/

GPA: recognition and ED management, with a focus on pulmonary-renal red flags and when to treat before confirmatory testing returns.

Hosts
Phoebe Draper, MD
Brian Gilberti, MD

Listen: https://media.blubrry.com/coreem/content.blubrry.com/coreem/GPA.mp3
Download: https://media.blubrry.com/coreem/content.blubrry.com/coreem/GPA.mp3
Comments: https://coreem.net/podcast/episode-211-granulomatosis-with-polyangiitis/#comments

Key points
• GPA is a small-vessel vasculitis that can involve the upper airway (sinusitis, otitis), lungs (nodules, alveolar hemorrhage), and kidneys (rapidly progressive glomerulonephritis).
• Red flags: chronic sinus symptoms, hemoptysis (especially bright red), new pulmonary complaints, renal dysfunction, and constitutional symptoms (fatigue, weight loss, fever).
• ED workup: CBC and CMP (anemia, AKI), urinalysis with microscopy (hematuria, RBC casts), chest imaging (CXR or CT for nodules or cavitary lesions).
• ANCA testing is important diagnostically but may not be immediately available. Do not delay treatment if suspicion is high and the patient is unstable.
• Stable patients: urgent outpatient workup and rheumatology follow-up.
• Unstable patients or suspected pulmonary-renal syndrome: high-dose IV steroids are a key early step, with ICU-level care and coordination for definitive therapy as indicated.
• Mimics to keep in mind: anti-GBM disease (Goodpasture), TB or fungal infection, malignancy, and other vasculitides (EGPA, MPA, lupus).
• ANCA patterns: PR3-ANCA (often c-ANCA pattern) is commonly associated with GPA; MPO-ANCA (often p-ANCA pattern) is more common in MPA.

Видео Episode 211: Granulomatosis with Polyangiitis канала Core EM