Rare Case of Granulomatosis with Polyangiitis: Ocular Involvement

The purpose of this chapter is to shed light on a rare cause of choroidal granuloma and the challenges in management. A 32-year-old man presented with gradual blurring of vision in the right eye (RE). He had a clear cornea, no conjunctival congestion, anterior chamber reaction 0.5+ and moderate vitritis, and a yellowish choroidal mass inferior to the disc with bilateral sclerosed ocular vessels in the periphery. The patient was investigated systemically and found to have c-ANCA positivity and eosinophilia. With a provisional diagnosis of Wegener’s granulomatosis with choroidal granuloma, the patient was started on oral steroids, and on tapering the steroids the patient had a recurring increase in size and exudation of the granuloma. In conjunction with the treating chest physician, the patient was started on immunosuppressants, and slow tapering of steroids resulted in visual and symptomatic improvement in the patient. To conclude, all possible causes of choroidal granuloma should be kept in mind while investigating. The treatment should be multidisciplinary with various specialists working synergistically for an optimal visual outcome.