Missing Orbital Bones in a Patient with Granulomatosis with Polyangiitis

Abstract

An 80-year-old woman presented with gradually progressing rhinorrhea and an inferiorly deviated right eye (Fig A). She was diagnosed with granulomatosis with polyangiitis (GPA) based on the presence of vasculitis on a biopsy of skin ulcers on her lower legs (Fig B, C). Laboratory findings showed elevated levels of C-reactive protein and erythrocyte sedimentation rate; however, serum anti-neutrophil cytoplasm antibodies were negative. Computed tomography revealed absent right orbital medial and inferior walls (Fig D, E).