The patient, a 74-year-old woman, was admitted with nine-year recurrent ocular redness, four-year otorhinolaryngological and ophthalmic pain, and five-month left toe purulent drainage. Laboratory tests showed leukocytosis, elevated C-reactive protein (193.6 mg/L, reference range <10 mg/L), erythrocyte sedimentation rate (68 mm/h, reference range 0–20 mm/h), and a low titer of proteinase 3-antineutrophil cytoplasmic antibody (37.75 RU/mL, reference range 0–20 RU/mL). Clinical examination revealed right palpebral fissure narrowing and a saddle nose deformity. Imaging indicated sinusitis (Figure 1A), mastoiditis, and cavitary pulmonary nodules (Figure 1B), suggesting granulomatosis with polyangiitis (GPA). During glucocorticoid tapering, she experienced painless vaginal bleeding. Colposcopy showed severe cervical “cauliflower-like” erosions and right vaginal wall ulcers (Figure 1C). Pelvic magnetic resonance imaging suggested cervical cancer (Figure 1D) and subsequent positron emission tomography–computed tomography examination revealed local hypermetabolism (Figure 1E), supporting oncological findings. Repeated pathologic examinations (three samplings, including two thin-preparation cytology tests and one biopsy) consistently demonstrated chronic mucosal inflammation (Figure 1F), leading to the final diagnosis of cervical and uterine involvement in GPA, a manifestation that is exceedingly rare in GPA. Intensified treatment with high-dose glucocorticoids and rituximab led to a significant clinical improvement. All data generated during this study are included in this published article. Consent obtained directly from patient. Supported by the National Natural Science Foundation of China (grant 82402103 to Dr Zhu), the Major Special Project of the National Health Commission of the People's Republic of China (grant 2025ZD18010 to Dr Zhu), the Natural Science Foundation of Beijing Municipality (grant 7244425 to Dr Zhu), and the Research and Development Foundation of Peking University People's Hospital (grants RDJP2023-01, RDL2024-17, and RDLX2025-1 to Dr Zhu). Disclosure form. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Xu et al. (Wed,) studied this question.