Episode 211: Granulomatosis with Polyangiitis

Earn 12.5 AMA PRA Category 1 Credits™ with the Core EM Modular CME Course. 12 curated EM modules with audio-first learning, plus quizzes and downloadable resources. Start here: https://www.highmarksce.com/nyumc/Pla... Granulomatosis with Polyangiitis (GPA) (Core EM Podcast, Episode 211) Podcast page: https://coreem.net/podcast/episode-21... GPA: recognition and ED management, with a focus on pulmonary-renal red flags and when to treat before confirmatory testing returns. Hosts Phoebe Draper, MD Brian Gilberti, MD Listen: https://media.blubrry.com/coreem/cont... Download: https://media.blubrry.com/coreem/cont... Comments: https://coreem.net/podcast/episode-21... Key points • GPA is a small-vessel vasculitis that can involve the upper airway (sinusitis, otitis), lungs (nodules, alveolar hemorrhage), and kidneys (rapidly progressive glomerulonephritis). • Red flags: chronic sinus symptoms, hemoptysis (especially bright red), new pulmonary complaints, renal dysfunction, and constitutional symptoms (fatigue, weight loss, fever). • ED workup: CBC and CMP (anemia, AKI), urinalysis with microscopy (hematuria, RBC casts), chest imaging (CXR or CT for nodules or cavitary lesions). • ANCA testing is important diagnostically but may not be immediately available. Do not delay treatment if suspicion is high and the patient is unstable. • Stable patients: urgent outpatient workup and rheumatology follow-up. • Unstable patients or suspected pulmonary-renal syndrome: high-dose IV steroids are a key early step, with ICU-level care and coordination for definitive therapy as indicated. • Mimics to keep in mind: anti-GBM disease (Goodpasture), TB or fungal infection, malignancy, and other vasculitides (EGPA, MPA, lupus). • ANCA patterns: PR3-ANCA (often c-ANCA pattern) is commonly associated with GPA; MPO-ANCA (often p-ANCA pattern) is more common in MPA.