Core EM - Emergency Medicine Podcast

Episode 211: Granulomatosis with Polyangiitis

Listen Later

Granulomatosis with Polyangiitis (GPA) – Recognition and Management in the ED

Hosts:

Phoebe Draper, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/GPA.mp3
Download
One Comment
Tags: Rheumatology
Show Notes
Background
  • A vasculitis affecting small blood vessels causing inflammation and necrosis
  • Affects upper respiratory tract (sinusitis, otitis media, saddle nose deformity), lungs (nodules, alveolar hemorrhage), and kidneys (rapidly progressive glomerulonephritis)
  • Can lead to multi-organ failure, pulmonary hemorrhage, renal failure
    • Red Flag Symptoms:
    • Chronic sinus symptoms
    • Hemoptysis (especially bright red blood)
    • New pulmonary complaints
    • Renal dysfunction
    • Constitutional symptoms (fatigue, weight loss, fever)
      • Workup in the ED:
      • CBC, CMP for anemia and AKI
      • Urinalysis with microscopy (hematuria, RBC casts)
      • Chest imaging (CXR or CT for nodules, cavitary lesions)
      • ANCA testing (not immediately available but important diagnostically)
        • Management:
        • Stable patients: Outpatient workup, urgent rheumatology consult, prednisone 1 mg/kg/day
        • Unstable patients: High-dose IV steroids (methylprednisolone 1 g daily x3 days), consider plasma exchange, cyclophosphamide or rituximab initiation, ICU admission
          • Conditions that Mimic GPA:
          • Goodpasture syndrome (anti-GBM antibodies)
          • TB, fungal infections
          • Lung malignancy
          • Other vasculitides (EGPA, MPA, lupus)
            • ANCA Testing Utility:
            • C-ANCA/PR3-ANCA positive in 80-90% of GPA cases
            • P-ANCA/MPO-ANCA more common in MPA
            • Don’t delay treatment while awaiting results if suspicion is high
              • Outcomes:
              • Without treatment: Fatal within a year (renal failure, respiratory complications)
              • With treatment: 5-year survival ~75-90%, but ~50% relapse rate
              • Long-term rheumatology follow-up is essential
                • Take-Home Points:
                • Always include vasculitis in the differential for unexplained respiratory, renal, or systemic symptoms.
                • Recognize pulmonary-renal syndromes early.
                • Initiate high-dose steroids immediately for unstable patients without waiting for ANCA results.
                • GPA is rare but life-threatening – early recognition saves lives.

                  • Read More
                  ...more
                  View all episodesView all episodes
                  Download on the App Store
                  Core EM - Emergency Medicine PodcastBy Core EM
                  • 4.5
                  • 4.5
                  • 4.5
                  • 4.5
                  • 4.5

                  4.5

                  237 ratings

                  More shows like Core EM - Emergency Medicine Podcast

                  View all
                  EMCrit FOAM Feed by Scott D. Weingart, MD FCCM

                  EMCrit FOAM Feed

                  1,869 Listeners

                  Emergency Medicine Cases by Dr. Anton Helman

                  Emergency Medicine Cases

                  534 Listeners

                  JAMA Clinical Reviews by JAMA Network

                  JAMA Clinical Reviews

                  493 Listeners

                  The Resus Room by Simon Laing, Rob Fenwick & James Yates

                  The Resus Room

                  100 Listeners

                  EM Clerkship by Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

                  EM Clerkship

                  809 Listeners

                  The Curbsiders Internal Medicine Podcast by The Curbsiders Internal Medicine Podcast

                  The Curbsiders Internal Medicine Podcast

                  3,327 Listeners

                  Emergency Medical Minute by Emergency Medical Minute

                  Emergency Medical Minute

                  258 Listeners

                  Core IM | Internal Medicine Podcast by Core IM Team

                  Core IM | Internal Medicine Podcast

                  1,114 Listeners

                  The Internet Book of Critical Care Podcast by Adam Thomas & Josh Farkas

                  The Internet Book of Critical Care Podcast

                  715 Listeners

                  The Clinical Problem Solvers by The Clinical Problem Solvers

                  The Clinical Problem Solvers

                  514 Listeners

                  Harrison's PodClass: Internal Medicine Cases and Board Prep by AccessMedicine

                  Harrison's PodClass: Internal Medicine Cases and Board Prep

                  349 Listeners

                  Run the List by Walker Redd, Emily Gutowski, Navin Kumar, Joyce Zhou, Blake Smith

                  Run the List

                  248 Listeners

                  Critical Care Scenarios by Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM

                  Critical Care Scenarios

                  251 Listeners

                  The Curious Clinicians by The Curious Clinicians

                  The Curious Clinicians

                  364 Listeners

                  Critical Care Time by Critical Care Time Podcast

                  Critical Care Time

                  237 Listeners