Symptoms of Granulomatosis with Polyangiitis
The symptoms of granulomatosis with polyangiitis vary widely depending on which organs are affected, but typically include a mix of respiratory, renal, and generalised inflammatory signs. The symptoms of granulomatosis with polyangiitis often start gradually and may initially resemble common illnesses such as sinusitis or the flu, making early diagnosis challenging. However, as the disease progresses, organ damage may become more pronounced, sometimes resulting in life-threatening complications if left untreated.
Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis that causes inflammation of small- and medium-sized blood vessels, particularly in the lungs, kidneys, and upper airways. Granulomas—clusters of inflammatory cells—also form in tissues, further contributing to damage. Because GPA can affect virtually any organ system, the symptoms are diverse and may develop over days, weeks, or even months.
General Symptoms
In the early stages, people often experience non-specific systemic symptoms such as:
Fatigue and low energy
Weight loss without trying
Fever and night sweats
Loss of appetite
Joint and muscle aches resembling arthritis
Mild anaemia or generalised weakness
These symptoms often precede more localised organ involvement and are sometimes mistaken for viral infections or chronic fatigue syndrome.
Upper Respiratory Tract Involvement
The upper respiratory tract is involved in over 90% of cases. Common symptoms include:
Chronic sinusitis or persistent nasal congestion
Bloody or crusted nasal discharge
Nosebleeds (epistaxis)
Nasal septal perforation, which may lead to a saddle-nose deformity
Hearing loss due to eustachian tube dysfunction
Ear pain, fullness, or infections
These symptoms are often recurrent and may resist standard treatment with antibiotics or decongestants, raising suspicion of an underlying inflammatory process.
Lower Respiratory Tract Symptoms
Lung involvement is another hallmark of GPA and may present with:
Chronic dry cough
Shortness of breath
Chest pain, especially on deep breathing
Coughing up blood (haemoptysis)
Wheezing or crackles on examination
Chest X-rays or CT scans may reveal nodules, infiltrates, or cavities—sometimes misinterpreted as infections, tuberculosis, or cancer.
In severe cases, lung haemorrhage can occur, requiring urgent treatment.
Kidney Involvement
Kidney inflammation, or glomerulonephritis, may be silent in early stages but is one of the most serious manifestations:
Blood in the urine (haematuria)
Protein in the urine (proteinuria)
Foamy urine
High blood pressure
Swelling in the ankles or around the eyes
Without treatment, kidney function may deteriorate rapidly, leading to chronic kidney disease or kidney failure.
Eye and Vision Problems
Inflammation may extend to the eyes, resulting in:
Red, painful eyes
Blurred vision or double vision
Dry eyes
Episcleritis or scleritis (inflammation of the white part of the eye)
Vision loss in severe cases
Prompt ophthalmologic assessment is essential to preserve vision in affected individuals.
Skin Lesions
Skin symptoms occur in approximately 30–50% of cases. These may include:
Reddish or purple spots (purpura), particularly on the legs
Ulcers, especially on the extremities
Tender nodules or lumps
Rashes resembling allergic reactions
Skin biopsy may help confirm vasculitis as the cause of these lesions.
Nervous System Symptoms
The nervous system may also be affected, causing:
Peripheral neuropathy (numbness, tingling, or burning in the hands or feet)
Muscle weakness
Cranial nerve palsies
Rarely, stroke-like episodes or central nervous system involvement
Neurological symptoms can be subtle or debilitating, depending on the nerves involved.
Gastrointestinal Involvement
Although less common, the gastrointestinal system can also be affected, leading to:
Abdominal pain
Nausea or vomiting
Gastrointestinal bleeding or ulcers
These symptoms may mimic other GI conditions and complicate diagnosis.
Symptoms in Children
Granulomatosis with polyangiitis is rare in children but presents similarly:
Fever, weight loss, and fatigue
Ear, nose, and throat infections that do not resolve
Joint pain or swelling
Haematuria or proteinuria
Paediatric diagnosis can be particularly challenging due to overlap with common childhood illnesses.
Patterns and Progression
There is no fixed sequence for symptom development:
Some individuals have isolated respiratory symptoms for months before kidney involvement appears
Others may present suddenly with multisystem disease
Flare-ups can alternate with periods of remission
This unpredictable pattern underscores the need for ongoing monitoring and early specialist referral.
Conclusion | Symptoms of Granulomatosis with Polyangiitis
The symptoms of granulomatosis with polyangiitis are diverse, ranging from sinus congestion and joint pain to life-threatening kidney failure or lung haemorrhage. Because the symptoms of granulomatosis with polyangiitis often mimic more common conditions, early recognition requires a high index of suspicion, especially in persistent or multisystem disease. Accurate diagnosis and early treatment are essential to reduce the risk of long-term complications and achieve remission.
