Diagnosis. Renal involvement is observed in 20% of the cases as the initial finding (7), and identified by focal segmental glomerulonephritis. In our patient, renal usg revealed normal findings except microhematuria detected in repeated complete urinalyses. The incidence of neurological involvement in wg is 50%. This includes the peripheral neuropathies in the form of polyneuropathy and mononeuropathy multiplex, and multiple cranial neural involvement developing with the nasal and sinus granulomas pervading the upper cranial nerves and the pharyngeal lesions pervading the lower cranial nerves. Narrowing of the carotid siphon due to cerebral arterial involvement, cases of aneurism secondary to this and lateral sinus obstruction due to mastoiditis have been reported (7). In untreated patients, seizures, stroke and encephalopathy may develop as the late complications (8). Our patient clinically meets the criteria of diagnosis (acr) based on the radiology and biopsy findings. The facilitative role of positive anca findings in the diagnosis of wg can not be denied (9). Peripheral neuropathy, a neurological complication was detected in our patient via emg diagnostic method. Diplopia due to episcleritis and limitation of ocular motion is another neurological complication. When all these findings were evaluated together, there was no suspicion about our diagnosis of wg. However, we believe that the repeated negative results for the immunological markers (anca) render our case rather interesting. Steroids are recommended for treatment. The monitoring of sedimentation may determine the efficacy of the treatment. While the mean rate of survival was 5 months in the 1960s, now this rate has increased up to 5 years in 75% of the cases with a combination of cyclophosphamide and prednisolon administered at high doses (10). viagra for sale cheap viagra online floridalighttacklecharters.com/thq-cheap-generic-viagra-gn/ cheap generic viagra how to buy generic viagra cheap generic viagra viagra without a doctor prescription cheap generic viagra http://floridalighttacklecharters.com/thq-buy-generic-viagra-online-cheap-tx/ viagra without a doctor prescription
In our patient, treatment was initiated with steroid at a dose of century mg/day. Response to treatment was achieved in the short-term with respect to pain and episcleritis in the left eye and lung findings. Due to the progression of diplopia and the occurrence of hematuria as another finding, he was put under follow-up at the rheumatology clinic with the addition of cyclophosphamide to steroid treatment. As a conclusion, wg should be considered in cases with cranial and peripheral neural involvement, and early diagnosis and treatmen.