Lower cranial nerve palsy during radiotherapy for glottic cancer in a patient with Wegener's granulomatosis: An interesting case report

Lazzari,Grazia; Briatico Vangosa,Alessandra; Assunta De Cillis,Maria; Buccoliero,Giovanni; Silvano,Giovanni

doi:10.3892/mco.2018.1748

Lower cranial nerve palsy during radiotherapy for glottic cancer in a patient with Wegener's granulomatosis: An interesting case report

Authors:
- Grazia Lazzari
- Alessandra Briatico Vangosa
- Maria Assunta De Cillis
- Giovanni Buccoliero
- Giovanni Silvano
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Affiliations: Department of Radiation Oncology, S. Giuseppe Moscati Hospital, I‑74100 Taranto, Italy, Department of Radiology, S. Giuseppe Moscati Hospital, I‑74100 Taranto, Italy, Department of Otorhinolaryngology, S. Giuseppe Moscati Hospital, I‑74100 Taranto, Italy, Department of Infectious Diseases, S. Giuseppe Moscati Hospital, I‑74100 Taranto, Italy
Published online on: October 19, 2018 https://doi.org/10.3892/mco.2018.1748
Pages: 147-152

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Abstract

The aim of the present study was to report an unusual case of multiple lower cranial nerve palsies in a patient with Wegener's granulomatosis (WG) during radiotherapy for glottic cancer. WG is an autoimmune disease characterized by necrotizing granulomas mainly in the upper and lower respiratory tract or kidneys; however, the involvement of cranial nerves is not uncommon. Prior to the use of cyclophosphamide (CYC) the 1‑year mortality rate was ~82%; the introduction of rituximab (RTX) has revolutionized the course of the WG, with remission rates comparable to those of CYC and superior effectiveness in relapsing patients. Hypogammaglobulinemia and B‑cell depletion are the best known monitored side effects affecting survival due to secondary infections. Immunodepression and relapse with lower cranial nerve palsy have a negative impact on prognosis. We herein present the case of a heavily pre‑treated GPA patient with secondary immunosuppression, who underwent radiotherapy for glottic cancer and developed multiple low cranial nerve palsies during treatment, which was interrupted at 60 Gy. The possible related causes and the association between previous immunosuppressive treatments and radiotherapy were also analyzed to elucidate the cause of this complication.

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