Granulomatosis with polyangiitis presenting with pachymeningitis.

OBSERVATIONS: This case report describes a 75 year-old Caucasian male who initially presented with persistent daily headaches. Physical exam elicited multiple cranial nerve palsies. Gadolinium-enhanced brain MRI demonstrated pachymeningitis. Labs revealed elevated proteinase-3 antineutrophil cytoplasmic antibodies (PR3-ANCA) and cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA), confirming a diagnosis of GPA.

CONCLUSION

GPA should be considered in older patients presenting with persistent daily headaches and pachymeningitis. Contrast-enhanced brain MRI is an important diagnostic tool.