Granulomatosis with polyangiitis (Wegener's granulomatosis) causing atlantoaxial instability: a case report

Background Context: No previous cases of atlantoaxial instability due to granulomatosis with polyangiitis have been reported. Purpose: The aim of this study was to report a case of granulomatosis with polyangiitis causing atlantoaxial instability. Study Design: This is a case report. Patient Sample: A 45-year-old woman participated in this study. Outcome Measures: The patient's pain and atlantoaxial instability were resolved. Methods: A 45-year-old Caucasian woman with a large ulcerative lesion in her oropharynx initially presented with chronic sinusitis, pharyngitis, and severe odynophagia. Years after her original symptoms began, she developed neck pain radiating into her upper trapezial region and shoulders. Results: Atlantoaxial fusion was performed on the patient, resolving her neck, upper trapezial, and shoulder pain. She was diagnosed with granulomatosis with polyangiitis (formerly Wegener's granulomatosis) and treated with cyclophosphamide. Conclusions: Granulomatosis with polyangiitis should be part of the working differential diagnosis for non-traumatic cervical spine injury. The atlantoaxial instability can be managed with stabilization, and the disease process itself can be treated with cyclophosphamide.