Successful Treatment with Rituximab for Granulomatosis with Polyangiitis and Multiple Cranial Neuropathies

Intern Med. 2021 Apr 1;60(7):1095-1099. doi: 10.2169/internalmedicine.4881-20. Epub 2020 Nov 2.


We herein report a case of granulomatosis with polyangiitis in a 73-year-old man. He had experienced bilateral ptosis, redness of both eyes, right facial weakness, and hearing loss in the right ear for two months. Myeloperoxidase anti-neutrophil cytoplasmic antibody was positive. Corticosteroids and intravenous cyclophosphamide pulse therapy yielded a response. After the fourth pulse of cyclophosphamide, he developed headache, diplopia, restricted left eye movement, right facial palsy, and hearing loss in the right ear. A one-year remission period was achieved by increasing the steroid and rituximab doses. Rituximab was effective against the relapse of granulomatosis with polyangiitis and cranial neuropathy.

Keywords: MPO-ANCA; cranial neuropathy; cyclophosphamide; granulomatosis with polyangiitis; rituximab.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antibodies, Antineutrophil Cytoplasmic
  • Cranial Nerve Diseases* / drug therapy
  • Granulomatosis with Polyangiitis* / diagnosis
  • Granulomatosis with Polyangiitis* / drug therapy
  • Humans
  • Male
  • Peroxidase
  • Rituximab / therapeutic use


  • Antibodies, Antineutrophil Cytoplasmic
  • Rituximab
  • Peroxidase