Letters to the Editor
In Reply
The title of the published clinical snapshot describes orbital involvement in granulomatosis with polyangiitis (GPA) without implying isolated involvement, which is confirmed by the clinical presentation of a saddle nose (1). The terms “medial” and “basal orbital cavity” are formally anatomically imprecise, but they refer to the walls of these. The orbital lamina forms the lateral surface of the labyrinth of the ethmoid bone and therefore constitutes most of the medial wall of the orbital cavity (as marked in the Figure). We followed the journal’s instructions and the format of a clinical “snapshot” by showing as an example only one CT scan of one plane. We agree that additional sectional planes would have been needed to show comprehensively the destruction of the nasal septum and of all nasal turbinates. The patient refused to have a biopsy specimen taken. Because of the unequivocal clinical presentation/symptoms and the established diagnosis (pulmonary and renal involvement, saddle nose, crusts, and a positive diagnostic PR3-ANCA test) we accepted without further discussion the patient’s decision in a setting of a highly positive classification (2). Interdisciplinary work-up and medical care provided by pulmonologists and renal specialists was ensured. The bloody nasal discharge (“rhinorrhea”) was mentioned in the introduction.
DOI: 10.3238/arztebl.m2024.0199
On behalf of the authors
Dr. med. Nils Schulz
Abteilung für Rheumatologie, klinische Immunologie, Osteologie und physikalische Medizin
Justus-Liebig-Universität Gießen, Campus Kerckhoff
n.schulz@kerckhoff-klinik.de
Conflict of interest statement
The author declares that no conflict of interest exists.
| 1. | Schulz N, Böttger P, Klemm P: Orbital floor involvement in granulomatosis with polyangiitis. Dtsch Arztebl Int 2024; 121: 533. VOLLTEXT |
| 2. | Robson JC, Grayson PC, Ponte C, et al.: American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis; : Ann Rheum Dis 2022; 81: 315–20 CrossRef |
