Collet Sicard syndrome secondary to granulomatosis with polyangiitis
DOI:
https://doi.org/10.18203/2320-6012.ijrms20233398Keywords:
Collet Sicard, Case report, CN palsy, GPAAbstract
Granulomatosis with polyangiitis (GPA) is a systemic vasculitis that affects small to medium-sized blood vessels. Although uncommon, cranial nerve (CN) involvement can result in CN palsy. We present a clinical case of a female with collet Sicard syndrome (CSS), displaying left-sided CN IX, X, XI, and XII involvement, which we determined to be caused by GPA. Our patient met 7 points on the American College of Rheumatology 2018 (ACR) criteria for GPA with positive ANCA, bilateral mastoiditis, and decreased sensorineural hearing. Early identification of GPA is crucial due to systemic CN involvement, as it can lead to dysphonia, dysphagia, and other complications. Early treatment can improve the functional prognosis of patients, requiring intensive induction immunosuppression due to frequent bilateral progression and worse prognosis. Despite its infrequency, timely diagnosis is critical for better patient outcomes.
References
Ntatsaki E, Carruthers D, Chakravarty K, D’Cruz D, Harper L, Jayne D, et al. BSR and BHPR guideline for the management of adults with ANCA- associated vasculitis. Rheumatology (Oxford). 2014;53(12):2306-9.
Stone JH, Wegener’s Granulomatosis Etanercept Trial Research G. Limited versus severe Wegener’s granulomatosis: baseline data on patients in the Wegener’s granulomatosis etanercept trial. Arthritis Rheum. 2003;48(8):2299-309.
Peters JE, Salama AD, Ind PW. Wegener’s granulomatosis presenting as acute systemic vasculitis following 20 years of limited tracheobronchial disease. J Laryngol Otol. 2009;123(12):1375-7.
Climans SA, Melanson M, Desai JA. A case of Collet Sicard Syndrome caused by necrotizing otitis externa. Can J Neurological Sci. 2013;40(2):268-70.
Handley TP, Miah MS, Majumdar S, Hussain SS: Collet-Sicard syndrome from thrombosis of the sigmoid- jugular complex: a case report and review of the literature. Int J Otolaryngol. 2010;2010:10.1155/2010/203587.
Yates M, Watts RA, Bajema IM, Cid MC, Crestani B, Hauser T, et al. EULAR/ ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis. 2016;75(9):1583-94.
Peters JE, Burke CJ, Morris VH. Three cases of rheumatoid arthritis with laryngeal stridor. Clin Rheumatol. 2011;30(5):723-7.
De Groot K, Schmidt DK, Arlt AC, Gross WL, Reinhold-Keller E. Standardized neurologic evaluations of 128 patients with Wegener granulomatosis. Arch Neurol. 2001;58(8):1215-21.
Nishino H, Rubino FA, DeRemee RA, Swanson JW, Parisi JE. Neurological involvement in Wegener’s granulomatosis: an analysis of 324 consecutive patients at the Mayo Clinic. Ann Neurol. 1993;33(1):4-9.
Seror R, Mahr A, Ramanoelina J, Pagnoux C, Cohen P, Guillevin L. Central nervous system involvement in Wegener granulomatosis. Medicine (Baltimore). 2006;85(1):54-65.
Yokoseki A, Saji E, Arakawa M, Kosaka T, Hokari M, Toyoshima Y, et al. Hypertrophic pachymeningitis: significance of myeloperoxidase anti- neutrophil cytoplasmic antibody. Brain. 2014;137(Pt 2):520-36.
Faurschou M, Westman K, Rasmussen N, de Groot K, Flossmann O, Hoglund P, et al. Brief report: long-term outcome of a randomized clinical trial comparing methotrexate to cyclophosphamide for remission induction in early systemic antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum. 2012;64(10):3472-7.
Stone JH, Merkel PA, Spiera R, Seo P, Langford CA, Hoffman GS, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010;363(3):221-32.
Jones RB, Tervaert JW, Hauser T, Luqmani R, Morgan MD, Peh CA, et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med. 2010;363(3):211-20.
Chang W, Zhou G, Shi Q, Zhang XF, Zhang FC. Clinical analysis of nervous system involvement in ANCA-associated systemic vasculitides. Clin Exp Rheumatol. 2009;27:S65-9.
