Extremely rare complication of granulomatosis with polyangiitis: Aneurysmal subarachnoid haemorrhage

Abstract

The systemic vasculitis of the small-medium arteries, arterioles, venules and rarely large arteries that involves respiratory system and kidneys was defined as Granulomatosis with Polyangiitis (GPA) disease by Wegener in 1936. Intracranial aneurysms and subarachnoid haemorrhage (SAH) are extremely rare complications of GPA and our case will be the 2nd case treated with clipping aneurysm and the 11th case with subarachnoid haemorrhage in the literature.

A 43-year-old man presented to the emergency room with a severe headache and was admitted for further evaluation. He had GPA diagnosis 14 years ago with cytoplasmic anti-neutrophil cytoplasmic antibody (C-ANCA) and PR3-ANCA positive laboratory tests and kidney biopsy. SAH was seen on cranial computed tomography (CT) images. Then cerebral digital substraction angiography (DSA) performed and right middle cerebral artery aneurysm exposed. Aneurysm was clipped without any complication.

Intracranial aneurysms and SAH are extremely rare complications of GPA. GPA related aneurysmal SAH is an exceptional condition in neurovascular pathology. Monitoring patients with GPA for SAH must be remembered and kept in mind as a diagnosis.