Rhinosinusal involvement in granulomatosis with polyangiitis – clinical insights

Abstract BACKGROUND. Granulomatosis with polyangiitis (GPA) is a systemic necrotising vasculitis in which rhinosinusal disease is the most frequent and often earliest manifestation. Because sinonasal symptoms mimic chronic rhinosinusitis and other destructive midline disorders, timely diagnosis is frequently delayed. MATERIAL AND METHODS. This review synthesizes current evidence on the clinical presentation, investigation, diagnosis, and management of rhinosinusal manifestations of GPA, with emphasis on endoscopic, radiologic, serologic, and histopathological findings. It also outlines ENT-specific approaches to local care and their integration with systemic immunosuppression. RESULTS. Sinonasal involvement occurs in 70–90% of GPA cases, commonly preceding pulmonary or renal disease. Characteristic but non-specific endoscopic findings include crusting, ulceration, and necrosis, while imaging may demonstrate mucosal thickening and bony destruction. ANCA serology and biopsy support diagnosis but have limited sensitivity in localized disease, requiring multidisciplinary correlation. Management is centered on systemic immunosuppression (glucocorticoids with rituximab or cyclophosphamide), complemented by local measures such as saline irrigation, debridement, and topical corticosteroids. Surgery is reserved for complications or reconstructive purposes in remission. CONCLUSION. Rhinosinusal disease is both a diagnostic entry point and a major determinant of morbidity in GPA. Early recognition, coordinated multidisciplinary evaluation, and balanced integration of systemic and local therapies are essential to reduce irreversible damage and improve longterm outcomes.