Phrenic Nerve Paralysis as the Initial Presentation of Granulomatosis with Polyangiitis

Granulomatosis with PolyAngiitis (GPA) is a rare vasculitic condition best known for its predilection to involve the renal and respiratory system [1]. This disease, like many other vasculitides often presents with peripheral neurologic findings. Of these, mononeuritis multiplex, (i.e. wrist drop and foot drop) has been found to be most common [2, 3]. In our example, we present a unique case of GPA in which the initial symptom is unilateral phrenic nerve paralysis. An extensive literature review shows that this type of mononeuritis multiplex has not been reported in the United States as a presenting symptom of GPA.