Treatment-resistant chronic headaches and focal pachymeningitis in a 46-year-old man: a rare presentation of Wegener's granulomatosis

Abstract

Case presentation Since October, 2006, a 46-year-old white male had increasingly severe and permanent facial pain that started in the left maxilla and radiated over the left side of his face and head. By January, 2007, the intensity of pain had increased to the extent where it caused insomnia. The symptoms were not accompanied by fever, night sweats, weight loss, or any other evidence of an underlying systemic condition. Two healthy teeth were extracted without any benefi t. The pain was not orthostatic because it was aggravated when the patient was lying down, and it did not respond to non-steroidal anti-infl ammatory drugs or opioids. The patient’s medical history was unremarkable with no history of autoimmune disease, neoplasia, arthralgia, cardiopulmonary disorders, nor dermatological diseases. There was no history of epistaxis, sinusitis, or any other disorders of the ears, nose, or throat. He was a heavy smoker (about 30 pack-years) but denied alcohol consumption or any other substance abuse and was not on any regular medication. Clinical and neurological examinations, including consultation with an ear, nose, and throat specialist, did not fi nd any distinctive features. Notably, he had no clinical signs of meningeal involvement or sinusitis. Apart from mild left papilloedema, an ophthalmological examination was also unremarkable.