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A single-center retrospective cohort study described nine patients who underwent kidney transplants and developed various types of carcinoma during immunosuppression treatment for granulomatosis with polyangiitis or microscopic polyangiitis. The patients received a combination of drugs such as cyclophosphamide, prednisone, basiliximab, methylprednisolone, azathioprine, tacrolimus, mycophenolate mofetil, everolimus, or ciclosporin. The study highlighted the development of renal-cell carcinoma, squamous-cell carcinoma, metastatic undifferentiated squamous-cell carcinoma, or basal-cell carcinoma in these patients, emphasizing the potential toxicities associated with immunosuppressive therapy. [Extracted from the article]

A 73-year-old man with ANCA-associated vasculitis (AAV) and granulomatosis with polyangiitis (GPA) experienced lack of efficacy during treatment with epinephrine for gastrointestinal bleeding. Despite undergoing various procedures and therapies, including coil embolisation and endoclips placement, his bleeding persisted. Ultimately, he required repeat surgery and additional medications, such as rituximab and dapsone, to achieve remission and prevent relapse of AAV. [Extracted from the article]

A 79-year-old woman experienced lack of efficacy during treatment with iron for iron deficiency anaemia and methylprednisolone for granulomatosis with polyangiitis. Despite oral iron replacement therapy, her haemoglobin levels remained low, necessitating a blood transfusion. Subsequent treatment with methylprednisolone led to respiratory exacerbation, prompting a diagnosis of granulomatosis with polyangiitis. Treatment with cyclophosphamide and corticotherapy resulted in improved renal function, respiratory symptoms, and anaemia stability. [Extracted from the article]

A 71-year-old woman developed pneumatosis cystoides intestinalis (PCI) while being treated with methylprednisolone for granulomatosis with polyangiitis (GPA) and acarbose for diabetes mellitus. The woman's treatment history and diagnostic tests led to the conclusion that the PCI was secondary to the medications. Despite being asymptomatic, the woman did not receive any treatment for the PCI, and follow-up tests in August 2024 showed that the gas-filled cysts in her colon wall were still present but had improved. [Extracted from the article]

A 61-year-old woman experienced a paradoxical exacerbation of sclerouveitis while being treated with rituximab for the same condition. The woman initially presented with symptoms in her left eye, which led to the diagnosis of granulomatosis with polyangiitis. Despite responding well to prednisolone, her condition worsened after receiving rituximab infusions, causing severe ocular inflammation. Treatment was adjusted, and the inflammation eventually resolved, although further interventions were required to address complications. Due to this adverse reaction, rituximab was not considered for future treatment of sclerouveitis. [Extracted from the article]

A 76-year-old woman developed invasive cutaneous aspergillosis while undergoing treatment with rituximab, cyclophosphamide, and corticosteroids for a relapse of granulomatosis with polyangiitis. She presented with erythematous nodular skin lesions, and a biopsy confirmed the diagnosis. The invasive cutaneous aspergillosis was attributed to the immunosuppressive effects of the medications. Treatment with voriconazole resulted in a positive outcome for the patient. [Extracted from the article]

A 64-year-old man developed anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis while being treated with hydralazine for hypertension. He had a history of various health conditions and had been on hydralazine for 2.5 years before presenting with symptoms of anaemia. After diagnosis, hydralazine was discontinued, and he was started on steroids, leading to an improvement in symptoms and stabilisation of haemoglobin levels. [Extracted from the article]

A 57-year-old woman developed neuropathy while being treated with bortezomib for IgG lambda monoclonal gammopathy of undetermined significance. She had a complex medical history, including cryoglobulinaemic vasculitis and granulomatosis with polyangiitis, and was initially on methotrexate and prednisone. After experiencing neuropathy, her treatment was switched to daratumumab in October 2023. [Extracted from the article]

A 76-year-old woman developed a gastric ulcer perforation while being treated with prednisone for granulomatosis with polyangiitis (GPA). Despite also receiving rituximab and unspecified steroids for GPA, she exhibited a lack of efficacy. The woman initially presented with shortness of breath and cough, and her condition deteriorated despite treatment, ultimately leading to her passing away. The case highlights the challenges and complications that can arise in the treatment of GPA. [Extracted from the article]

A 55-year-old man experienced a rebound effect in the form of granulomatosis with polyangiitis (GPA) flare-up after tapering immunosuppressants and discontinuing rituximab. He presented with ocular symptoms, including subretinal fluid and serous retinal detachment, indicating ocular involvement of GPA. Blood tests and imaging confirmed the flare-up, leading to an increase in his medication doses to manage the condition. [Extracted from the article]

A 10-year-old boy developed drug-induced liver injury (DILI) while being treated for granulomatosis with polyangiitis (GPA) with avacopan, methylprednisolone, and rituximab. He experienced symptoms such as abdominal pain, diarrhea, gingivitis, and purpura before being diagnosed with GPA. After discontinuing avacopan and rituximab, his liver function improved, indicating a possible link between the medications and the liver injury. [Extracted from the article]

Three patients with microscopic polyangiitis and granulomatosis developed serious adverse events, including cerebral infarction, multiple organ failure, and gastrointestinal bleeding while receiving rituximab treatment. Unfortunately, all three patients ultimately passed away as a result of these complications. The study highlights the potential risks associated with rituximab therapy for these conditions, emphasizing the importance of monitoring and managing adverse effects. [Extracted from the article]

A 48-year-old woman experienced lack of efficacy during treatment for scleritis with cefotaxime, gentamicin, amikacin, ceftazidime, and levofloxacin. Despite receiving these medications, her condition deteriorated, leading to blindness in her right eye and eventual enucleation. Subsequent diagnosis revealed Staphylococcus arlettae and granulomatosis with polyangiitis, for which she received rituximab, steroids, mycophenolate-mofetil, and cyclophosphamide, resulting in symptom resolution and stable condition. [Extracted from the article]

A 60-year-old woman developed Stevens-Johnson syndrome while being treated with voriconazole for pulmonary aspergillosis. She had been diagnosed with granulomatosis with polyangiitis (GPA)-associated chronic obstructive pulmonary disease (COPD) and was initially treated with methotrexate. After experiencing complications and positive tests for Aspergillus species, voriconazole was replaced with caspofungin, leading to the resolution of the infection. Methotrexate treatment was temporarily halted during the management of the aspergillosis but was later resumed successfully. [Extracted from the article]

The article describes five cases of patients, three men and two women aged 74-88, who experienced lack of efficacy while being treated with avacopan for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. One patient also exhibited a rebound effect in the form of microscopic polyangiitis (MPA) symptoms flaring after a reduction in prednisolone dosage. Despite treatment with avacopan, the patients' conditions did not improve, leading to discontinuation of avacopan and alternative treatments to induce remission. [Extracted from the article]

A 76-year-old man experienced various toxicities while being treated for Pneumocystis jirovecii pneumonia (PJP) and granulomatosis with polyangiitis. He developed nephrotoxicity and acute kidney injury from cotrimoxazole, and methaemoglobinaemia from primaquine. He also exhibited a lack of efficacy from atovaquone. Despite these complications, the man's condition improved with the use of different medications, including dapsone, trimethoprim, micafungin, and clindamycin. Ultimately, there was no recurrence of PJP. [Extracted from the article]

A 72-year-old woman with granulomatosis with polyangiitis (GPA) exhibited a lack of efficacy during treatment with methylprednisolone and rituximab. She had a history of hypothyroidism, type 2 diabetes mellitus, and hearing loss. Despite receiving treatment, she developed disseminated intravascular coagulation (DIC) with haemorrhagic shock, irreversible ischaemia, and digital necrosis of multiple organs. Unfortunately, she passed away due to these complications. The cause of death was attributed to GPA, DIC, haemorrhagic shock, irreversible ischaemia, and digital necrosis of multiple organs. [Extracted from the article]

A retrospective chart review case series was conducted on 10 patients who developed reactivation of herpatic keratitis or herpes labialis or exhibited lack of efficacy during treatment for various types of scleritis. The patients were treated with drugs such as cyclophosphamide, mycophenolate-mofetil, methylprednisolone, tofacitinib, and unspecified steroids or corticosteroids. The cases described the patients' symptoms, treatments, and outcomes, highlighting the effectiveness of tofacitinib in improving symptoms of scleritis. However, some patients experienced adverse effects or lack of efficacy with certain medications. [Extracted from the article]

A case report published in Reactions Weekly describes a 17-year-old boy who developed severe diarrhea while being treated with cyclophosphamide for granulomatosis with polyangiitis (GPA). The boy initially presented with foot swelling, a lower extremity rash, and fatigue, and further investigation revealed severe anemia, hypertension, and tachycardia, leading to a diagnosis of GPA. He was treated with prednisone and cyclophosphamide, but later developed severe diarrhea, which required readmission. The boy's treatment was switched to rituximab after stopping cyclophosphamide. [Extracted from the article]

A retrospective chart review study examined 52 patients with necrotizing scleritis or scleritis associated with intraocular inflammation. Three case reports were described, involving two women and one man aged 45-63 years. These patients exhibited lack of efficacy with various drugs including methotrexate, methylprednisolone, azathioprine, mycophenolate mofetil, adalimumab, infliximab, prednisone, tocilizumab, rituximab, corticotropin, prednisolone acetate, valaciclovir, and cyclophosphamide. Alternative treatments such as cyclophosphamide, rituximab, methylprednisolone, ciclosporin, and tocilizumab were initiated in some cases, resulting in disease control. However, complications and disease recurrence were reported in some patients. [Extracted from the article]

A 72-year-old man developed cryptococcal prostatitis while being treated with prednisolone and tocilizumab for giant cell arteritis and granulomatosis with polyangiitis. He experienced perineal pain and urinary retention, and a digital rectal examination revealed a hardened nodule on his prostate. Pathological findings confirmed cryptococcal prostatitis, and further tests confirmed the presence of the cryptococcal antigen. The man was treated with fluconazole and his condition improved. This case highlights the potential side effects of prednisolone and tocilizumab therapy. [Extracted from the article]

A 59-year-old woman developed COVID-19 infection while undergoing treatment with rituximab for granulomatosis with polyangiitis. She experienced symptoms such as nausea, weakness, vomiting, and sweating, leading to a hospital admission where she was treated with favipiravir, anticoagulants, convalescent-anti-SARS-CoV-2-plasma, IV tocilizumab, and IV immune-globulin. After receiving these treatments, her condition improved, and she was discharged from the hospital on enoxaparin-sodium. [Extracted from the article]

A case report published in Reactions Weekly describes a 66-year-old woman with granulomatosis with polyangiitis (GPA) who exhibited lack of efficacy during treatment with methylprednisolone, cyclophosphamide, and mycophenolate. The woman had a history of polyarthritis and chronic sinusitis, and presented with worsening joint pain, rash, and persistent sinus symptoms. Despite initial improvement with treatment, she later developed GPA-associated macrophage activation syndrome and passed away. This case highlights the need for further research and alternative treatment options for patients with GPA. [Extracted from the article]

A 45-year-old woman with a history of hereditary haemolytic anaemia and granulomatosis with polyangiitis presented to the emergency department with symptoms of a herpetic infection. She was treated with aciclovir and vancomycin, but her condition worsened and she developed refractory septic shock and multiorgan dysfunction. Despite medical intervention, she ultimately died from the herpetic infection and its complications. The case highlights the lack of efficacy of aciclovir and vancomycin in this particular patient. [Extracted from the article]

A 76-year-old man experienced a rebound effect after reducing his dose of prednisolone for granulomatosis with polyangiitis (GPA). He initially presented with symptoms of GPA and was treated with prednisolone, which improved his condition. However, when the dose was tapered, he experienced dyspnea and pulmonary infiltration, indicating a rebound effect. The prednisolone dose was increased again, leading to resolution. Subsequent tapering of the dose resulted in symptoms of VEXAS syndrome, but these resolved with different medications. The patient remained in remission for one year after tapering prednisolone with methotrexate and infliximab. [Extracted from the article]

A 46-year-old man experienced a lack of efficacy while being treated with prednisolone for bilateral mastoiditis. Despite receiving the medication, he developed discharge from his left ear, indicating that the prednisolone was not effective. The man was later diagnosed with granulomatosis with polyangiitis (GPA) and started receiving treatment with methylprednisolone and cyclophosphamide, which led to clinical remission. However, he later developed brain abscesses but was able to achieve remission after receiving high-dose methylprednisolone and continued rituximab treatment. [Extracted from the article]

In a prospective observational study, two patients with granulomatosis with polyangiitis were described who exhibited lack of efficacy or developed COVID-19 during treatment with rituximab. The first patient was hospitalized but had no lung lesions on CT scan. The second patient had a severe lung lesion and developed a fatal outcome from COVID-19. These cases suggest that rituximab may not be effective in treating granulomatosis with polyangiitis and may be associated with COVID-19 infection. [Extracted from the article]

A 57-year-old woman with a medical history of type 2 diabetes and hypertension presented with symptoms of atypical pneumonia and was diagnosed with granulomatosis with polyangiitis vasculitis. She tested positive for beta-D-glucan and was treated with isavuconazole, along with other medications. However, her condition worsened, leading to intubation and a diagnosis of diffuse alveolar haemorrhage. She received additional treatments and eventually showed significant improvement. This case highlights the lack of efficacy of isavuconazole in this particular patient. [Extracted from the article]

A 40-year-old woman developed cryptogenic organising pneumonia (COP) while being treated with adalimumab for Crohn's disease. She experienced symptoms such as headache, malaise, fatigue, and worsening right-sided pleuritic chest pain. Despite initially being diagnosed with atypical pneumonia and receiving antibiotics, her condition did not improve. A lung biopsy revealed necrotic granulomas and micro-abscesses, leading to a diagnosis of COP as an adverse reaction to adalimumab. Treatment with prednisone resulted in rapid resolution of her symptoms and lung lesions. [Extracted from the article]

An 18-year-old woman developed central diabetes insipidus after stopping vasopressin treatment. She was initially admitted to the hospital for respiratory distress and was diagnosed with granulomatosis with polyangiitis. She received treatment with rituximab, glucocorticoids, and plasmapheresis. After being extubated, she developed acute pulmonary embolism and was re-intubated. During a diagnostic bronchoscopy, she experienced refractory hypotension and received vasopressin infusion. After 72 hours, the vasopressin was discontinued, and she subsequently developed polyuria and hypernatraemia. She was treated with desmopressin and eventually showed improvement. [Extracted from the article]

An 18-year-old woman developed central diabetes insipidus after stopping vasopressin treatment. She was initially admitted to the hospital for respiratory distress and was diagnosed with granulomatosis with polyangiitis. She received treatment with rituximab, glucocorticoids, and plasmapheresis. After being extubated, she developed acute pulmonary embolism and was re-intubated. During a diagnostic bronchoscopy, she experienced refractory hypotension and received vasopressin infusion. After 72 hours, the vasopressin was discontinued, and she subsequently developed polyuria and hypernatraemia. She was diagnosed with central diabetes insipidus related to vasopressin withdrawal and received desmopressin treatment, which improved her symptoms. [Extracted from the article]

A case series of 11 patients with granulomatosis with polyangiitis (GPA) was conducted to investigate the efficacy and safety of tofacitinib and rituximab. Among the 4 patients who received rituximab, one patient showed lack of efficacy despite treatment. All patients then received tofacitinib, but three of them also showed lack of clinical efficacy. Additionally, one patient developed pulmonary embolism as a result of tofacitinib treatment. The study highlights the need for further research on the effectiveness and safety of these medications for GPA. [Extracted from the article]

A man in his late 20s experienced a lack of effectiveness in his treatment for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Despite receiving multiple drugs, including rituximab, cyclophosphamide, methylprednisolone, prednisolone, and avacopan, his condition continued to worsen. He was then given off-label treatment with daratumumab, which resulted in a significant improvement in his condition. After receiving daratumumab, he was able to be discharged from the hospital and remained in remission as of January 2023. [Extracted from the article]

A case series of 11 patients with granulomatosis with polyangiitis (GPA) was conducted to investigate the efficacy and safety of tofacitinib and rituximab. Among the 4 patients who received rituximab, one patient showed lack of efficacy despite treatment. All patients then received tofacitinib, but three of them also showed lack of clinical efficacy. Additionally, one patient developed pulmonary embolism as a result of tofacitinib treatment. These findings suggest that both rituximab and tofacitinib may have limited effectiveness in treating GPA. [Extracted from the article]

A man in his late 20s experienced a lack of effectiveness with rituximab, cyclophosphamide, methylprednisolone, prednisolone, and avacopan for the treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. He also received off-label treatment with daratumumab for the same condition. Despite initial treatments, his disease progressed, and he required extracorporeal membrane oxygenation (ECMO). After starting daratumumab therapy, his condition improved, and he was eventually discharged from the hospital in remission. [Extracted from the article]

A 33-year-old man with chronic spontaneous urticaria (CSU) experienced a lack of efficacy while being treated with meprednisone. Despite receiving meprednisone, he continued to have recurrent swelling of the uvula, oedema of the eyelids, frequent tongue swelling, and swelling of the bilateral ear lobes. Biopsy results showed idiopathic localized angioedema, and the patient's symptoms improved when he restarted treatment with omalizumab. After three months of restarting omalizumab, his uvula swelling significantly resolved. This case highlights the lack of effectiveness of meprednisone in treating CSU in this particular patient. [Extracted from the article]

A 45-year-old man with granulomatosis with polyangiitis received treatment with methylprednisolone, cyclophosphamide, and corticosteroids. However, he was non-compliant with the treatment and was later admitted to the hospital with heart congestive failure and a skin ulcer. Despite receiving additional treatment, including methylprednisolone, cyclophosphamide, and corticosteroids, the man developed diffuse alveolar hemorrhage and died of respiratory failure. The lack of efficacy of the treatment was noted in this case. [Extracted from the article]

A 51-year-old woman developed steroid-dependent eosinophilic granulomatosis with polyangiitis while being treated with prednisone for granulomatosis with polyangiitis. She experienced an exacerbation of the disease when attempting to withdraw from prednisone and was referred to the hospital. Symptoms included moderate exertion, abdominal pain, dry cough, skin lesions, and diffuse myalgias. Diagnostic tests revealed pulmonary consolidation, restrictive ventilatory deficit, eosinophilia, proteinuria, and microhematuria. The woman was diagnosed with steroid-dependent eosinophilic granulomatosis with polyangiitis and was restarted on prednisone, in addition to receiving azathioprine therapy. [Extracted from the article]

A 15-year-old girl experienced a lack of efficacy while using chlorhexidine for gingivitis control. She sought an orofacial pain consultation due to jaw pain and headaches, and reported a history of nasal breathing difficulty and epiphora. The girl had undergone various procedures to address her symptoms, including surgery to remove a nasal mass. Despite using chlorhexidine for two months, she did not see any improvement in her gingival inflammation, leading to its discontinuation. The primary diagnosis considered was granulomatosis with polyangiitis (GPA). [Extracted from the article]

This article describes three cases of individuals who experienced various toxicities and complications related to the use of warfarin, a blood-thinning medication. In the first case, a 32-year-old man developed bleeding in the oral cavity and haematuria as a result of warfarin intoxication. The second case involves a 26-year-old woman who experienced haemorrhagic complications in the gastrointestinal and gynecological tract, leading to pulmonary thromboembolism. The third case involves a 35-year-old woman who experienced hypermenorrhagia and intense nosebleeds due to warfarin intoxication. These cases highlight the potential risks and complications associated with the use of warfarin. [Extracted from the article]

An 85-year-old woman with a history of chronic sinusitis, migratory polyarthralgia, chronic kidney disease, and anemia was admitted to the hospital with granulomatosis with polyangiitis. She was treated with methylprednisolone-sodium-succinate and unspecified steroids, but her condition continued to worsen. Despite being on steroids, her renal function deteriorated, her respiratory status worsened, and she developed septic shock. She was transferred to the medical intensive care unit, intubated, and started on broad-spectrum antibiotics for Klebsiella pneumoniae. Unfortunately, despite treatment, she developed multi-organ dysfunction and passed away. [Extracted from the article]

A 74-year-old man with granulomatosis with polyangiitis exhibited lack of efficacy during treatment with methylprednisolone-sodium-succinate and cyclophosphamide. He developed acute kidney injury, leukocytosis, and pauci-immune glomerulonephritis. Despite receiving various treatments, including plasma exchange and fresh frozen plasma, his condition continued to deteriorate. Eventually, he was switched to rituximab, which led to improvement and eventual discharge to rehabilitation. [Extracted from the article]

Author InformationAn event is serious (based on the ICH definition) when the patient outcome is:• * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important eventA 52-year-old woman exhibited treatment failure during treatment with rituximab and unspecified steroids and developed acute promyelocytic leukaemia (APL) during treatment with cyclophosphamide for granulomatosis with polyangiitis [GPA; not all dosages stated; routes and duration of treatment to reaction onset not stated]. [Extracted from the article]

Author InformationAn event is serious (based on the ICH definition) when the patient outcome is:• * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important eventA 53-year-old man developed oeosinophilic granulomatosis with polyangiitis (EGPA) during COVID-19 vaccination with COVID-19 vaccine [route and dosage not stated]. [Extracted from the article]

This article presents four case reports of patients with granulomatosis with polyangiitis who experienced lack of efficacy or adverse effects during treatment with various drugs. One patient developed reactivation of cytomegalovirus and herpes simplex virus type 1 while receiving rituximab. Another patient experienced deterioration of peripheral ulcerative keratitis and scleritis while using loteprednol. A third patient had multiple treatment failures and developed optic disc edema and thrombosis of the CNS venous sinuses. The fourth patient had relapses and skin ulcerations despite treatment with azathioprine and prednisolone. These case reports highlight the challenges in managing granulomatosis with polyangiitis and the need for individualized treatment approaches. [Extracted from the article]

This article presents two case reports of patients who developed disseminated cutaneous manifestation of non-tuberculous mycobacteriosis after receiving treatment with certolizumab pegol, prednisolone, or methotrexate. The first patient, a 76-year-old man with granulomatosis with polyangiitis, experienced fever, arthralgia, and skin changes on his extremities. Biopsy results confirmed the presence of non-tuberculous mycobacteria. The second patient, a 66-year-old woman with panniculitis and rheumatoid arthritis, also developed skin changes and tenosynovitis. Both patients showed improvement with antibiotic therapy. These case reports suggest a potential association between certolizumab pegol and the development of non-tuberculous mycobacteriosis. [Extracted from the article]

A 33-year-old man developed Aspergillus flavus infection, tuberculosis (TB), and multiple infections while receiving immunosuppressive therapy for suspected granulomatosis with polyangiitis. The man had a history of respiratory tract infections since childhood and a family history of interstitial lung disease. He underwent various treatments, including cyclophosphamide, methylprednisolone, azathioprine, and steroids. He was eventually diagnosed with chronic granulomatous disease, ruling out granulomatosis with polyangiitis. With prophylactic antibiotic treatments, his infections resolved, and the frequency of infections decreased. He was referred for further treatment options. [Extracted from the article]

A study reviewed medical records of patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) who developed various toxicities while undergoing immunosuppression therapy. The study identified eight patients, aged 52-82 years, who experienced soft tissue infection, Clostridium difficile colitis, necrotising fasciitis, pneumonia, or urothelial carcinoma. These adverse events were associated with the use of azathioprine, cyclophosphamide, hydrocortisone, methylprednisolone, mycophenolate-mofetil, prednisone, or rituximab. Some patients developed septic shock, cardiogenic shock, renal failure, respiratory failure, or cardiac arrest, and one patient required amputation. Unfortunately, all patients eventually died due to the complications mentioned above. [Extracted from the article]

A 48-year-old woman developed granulomatosis with polyangiitis (GPA) and facial paralysis after receiving the elasomeran (Spikevax) vaccine. She experienced symptoms such as headache, sore throat, and ear discomfort after the first dose, and developed otitis media and hearing loss after the second dose. She was admitted to the hospital multiple times for recurrent facial paralysis and was eventually diagnosed with GPA. The woman received various treatments for her condition, but her hearing loss did not improve significantly. She later tested positive for a SARS-CoV-2 infection. [Extracted from the article]

A 69-year-old woman experienced liver damage while being treated with azathioprine and vomiting while being treated with cyclophosphamide for otitis media with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis or granulomatosis with polyangiitis (GPA). She had a history of ANCA-associated vasculitis and had previously received treatment with prednisolone. The liver damage was believed to be caused by azathioprine, and her symptoms improved after discontinuing the medication. She also developed GPA and received monthly IV cyclophosphamide for 6 cycles, but experienced vomiting after the third cycle. Cyclophosphamide treatment was stopped, and she was switched to methylprednisolone. Her symptoms of GPA improved after restarting cyclophosphamide. [Extracted from the article]