SPLENIC INVOLVEMENT IN WEGENERS GRANULOMATOSIS

Objective.-A clinicopathologic review of splenic involvement in Wegene r's granulomatosis. Design.-A retrospective case review, spanning a 10 -year period, identified five patients with Wegener's granulomatosis a nd splenic involvement. Setting.-A large teaching hospital and outpati ent clinics. Interventions.-Cytotoxic therapy (cyclophosphamide and co rticosteroids), mechanical ventilation in respiratory failure, renal h emodialysis in renal failure, and general supportive care. Results.-Ne crotizing granulomatous inflammation and vasculitis with fibrinoid nec rosis were found in the spleen in one antemortem case. At autopsy, two cases demonstrated extensive infarction; microscopic examination reve aled parenchymal coagulative necrosis, microcalcification, and vascula r thrombosis, but no evidence of vasculitis. Two other cases showed no nspecific changes of diffuse hyalinization of blood vessels, vascular congestion, and hemosiderin deposition. Conclusions.-Splenic involveme nt in Wegener's granulomatosis is rarely diagnosed during life, occurs more frequently than once thought, and can occasionally lead to consi derable morbidity.