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Hegazy et al. Vessel Plus 2021;5:46 https://dx.doi.org/10.20517/2574-1209.2021.52 Page 5 of 8
Figure 3. A 34-year-old male patient with a nasal mass. Histology of the nasal mass showing vasculitis (black arrow), granulomatous
reaction (white arrows), and areas of necrosis (green arrow) [H&E, ×200 (original magnification), scale bar = 100 µm]. (Courtesy of Dr.
Maha Emad Eldein, Lecturer of Pathology, Department of Pathology, Faculty of Medicine, Cairo University, Egypt).
can be used as an alternative. Combination with glucocorticoid can be used in cases of severe disease. If
remission is not achieved, cyclophosphamide or rituximab can be used.
For maintenance of remission, methotrexate or azathioprine are recommended. Rituximab can be used as
an alternative. Treatment usually continues for two years and sometimes a longer duration may be
required [30,31] .
ROLE OF LOCAL ENT THERAPY AND COMMON INTERVENTIONS
Local ENT therapies are part of medical therapy of which immunosuppressive therapy is the keystone in the
management of GPA. Actively managing local ENT symptoms does improve the patient's quality of life and
- in some cases - is life-saving.
Topical saline nasal irrigations, antibiotic irrigations, and topical nasal steroids may alleviate bothersome
sino-nasal symptoms and reduce inflammation. Though being sterile in its origin, GPA can lead to
superimposed bacterial infection, and thus, culture-directed antimicrobial therapy may be necessary in
