Medicine (MD/DO)
Granulomatosis with Polyangiitis (GPA) Symptoms

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Granulomatosis with Polyangiitis (GPA) Symptoms

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Granulomatosis with Polyangiitis (GPA) Symptoms

Granny-llama with Polly-angel
Granulomatosis with Polyangiitis (GPA) manifests with diverse symptoms stemming from autoimmune inflammation affecting multiple organ systems. In the upper respiratory tract, individuals may experience characteristic features such as saddle nose deformity, perforation of the nasal septum, chronic sinusitis, otitis media, and mastoiditis. Lower respiratory symptoms include cough, hemoptysis (coughing up blood), and dyspnea (shortness of breath) due to inflammation and damage to the airways and lung tissues. Renal complications, notably Rapidly Progressive Glomerulonephritis (RPGN), manifest with symptoms of hematuria (blood in the urine) and the presence of red cell casts, cylindrical formations in the urine indicative of kidney damage. These symptoms collectively define the clinical profile of GPA, reflecting the autoimmune nature of the disease and underscoring the importance of prompt diagnosis and comprehensive management to address both systemic and organ-specific manifestations.
Saddle Nose
Saddle on Nose

Saddle nose is a characteristic deformity of the nose associated with Granulomatosis with Polyangiitis (GPA). This deformity results from the inflammation and destruction of the cartilage and bone in the bridge of the nose. As GPA affects the blood vessels supplying the nasal structures, the diminished blood flow can lead to weakening and collapse of the nasal bridge, creating a concave or "saddle-shaped" appearance. Saddle nose deformity is often a late-stage manifestation and can contribute to both functional and cosmetic challenges for individuals with GPA.

Perforation of Nasal Septum
Nose-ring through Hole in Nasal Septum

Perforation of the nasal septum is another notable feature of GPA that affects the upper respiratory tract. In this condition, the septum—the cartilage that divides the nostrils—is compromised by inflammation, leading to the formation of a hole or perforation. Chronic inflammation and damage to the blood vessels contribute to the weakening of the septum. As a result, individuals with GPA may experience nasal obstruction, epistaxis (nosebleeds), and an altered sense of smell. The perforation of the nasal septum is a distinctive clinical sign associated with GPA and is often part of the complex upper respiratory manifestations of the disease.

Chronic Sinusitis
Crone Sinner

Chronic sinusitis is a common manifestation of Granulomatosis with Polyangiitis (GPA) and results from the inflammatory process affecting the upper respiratory tract. In GPA, the immune system's misguided attack on blood vessels leads to inflammation in the sinus passages, causing persistent sinusitis. This chronic inflammation can result in symptoms such as nasal congestion, facial pain or pressure, postnasal drip, and reduced sense of smell. As GPA progresses, the inflammation can lead to structural changes in the sinus tissues, contributing to complications like saddle nose deformity and perforation of the nasal septum. Chronic sinusitis significantly impacts the quality of life for individuals with GPA, and its management often involves a combination of immunosuppressive therapy, nasal saline rinses, and, in some cases, surgical interventions to address structural abnormalities. Regular monitoring and treatment of chronic sinusitis are crucial aspects of GPA care to alleviate symptoms and prevent further complications in the upper respiratory tract.

Otitis Media

Otitis media is a condition involving inflammation of the middle ear, and it can be associated with Granulomatosis with Polyangiitis (GPA). In GPA, the inflammation affects the Eustachian tube, leading to impaired drainage and accumulation of fluid in the middle ear. This inflammatory process can result in symptoms such as ear pain, hearing loss, and a sensation of fullness in the ear. Otitis media in the context of GPA reflects the systemic impact of the disease on multiple organs, extending beyond the respiratory system to affect the ears.


Mastoiditis is inflammation of the mastoid bone, and it can be a complication of Granulomatosis with Polyangiitis (GPA) involving the upper respiratory tract. In GPA, inflammation spreads to the mastoid air cells, leading to swelling and discomfort behind the ear. Symptoms may include ear pain, redness, and the formation of a tender mass. If left untreated, mastoiditis can lead to serious complications. The presence of mastoiditis in GPA underscores the potential for the disease to affect various anatomical structures within the head and highlights the importance of comprehensive medical evaluation and management.

Coughing Coffee-pot

Cough is a common respiratory symptom associated with Granulomatosis with Polyangiitis (GPA). In GPA, inflammation of the lower respiratory tract can lead to irritation of the airways, resulting in a persistent cough. The cough may be dry or productive, often reflecting the inflammatory processes affecting the lungs and air passages. Monitoring the nature and persistence of the cough is important for assessing disease activity and guiding treatment decisions in individuals with GPA.


Dyspnea, or shortness of breath, is another important respiratory symptom associated with GPA. In GPA, inflammation and damage to the airways and lung tissue can lead to a reduced capacity for airflow, resulting in difficulty breathing. Dyspnea may be experienced during physical activity or at rest, depending on the severity of lung involvement. Monitoring dyspnea is crucial for assessing disease progression and guiding therapeutic interventions to alleviate respiratory symptoms and improve the overall quality of life for individuals with GPA.

Red-mop coughing blood

Hemoptysis refers to the coughing up of blood, and it is a significant symptom in the context of GPA. In GPA, the inflammation and damage to the blood vessels in the lungs can cause bleeding into the airways, leading to hemoptysis. This symptom can range from mild blood-tinged sputum to more severe and life-threatening episodes of coughing up blood. Hemoptysis is a serious manifestation of GPA, and prompt medical attention is essential to evaluate the extent of lung involvement and initiate appropriate treatment.

Rapidly Progressive Glomerulonephritis
Rapid-rabbit Glow-mare

Rapidly Progressive Glomerulonephritis (RPGN) is a severe and rapidly evolving form of kidney inflammation that can occur in individuals with Granulomatosis with Polyangiitis (GPA). In GPA, the immune system's attack on blood vessels extends to the glomeruli, the tiny blood vessels in the kidneys responsible for filtering waste from the blood. RPGN is characterized by a rapid decline in kidney function, leading to symptoms such as hematuria (blood in the urine) and red cell casts. Hematuria results from the presence of blood in the urine, which can give it a reddish or brownish color. Red cell casts, formed when red blood cells clump together in the kidney tubules, are often seen in the urine sediment. These symptoms indicate significant kidney damage and impaired filtration. Prompt recognition and management of RPGN are crucial to prevent further kidney deterioration and to address the systemic impact of GPA on renal function. Individuals experiencing hematuria and red cell casts should seek immediate medical attention for thorough evaluation and appropriate intervention.


Hematuria in GPA is a result of bleeding from the inflamed blood vessels within the kidneys. The presence of blood in the urine may vary in severity, and it is often an important clinical sign indicating renal involvement in the disease. Monitoring and addressing renal complications, such as glomerulonephritis and hematuria, are crucial aspects of managing GPA to prevent further kidney damage and maintain overall health. Individuals experiencing hematuria or other kidney-related symptoms should seek prompt medical attention for a thorough evaluation and appropriate management.

RBC Casts
RBC Casts

Red cell casts are structures found in the urine that indicate a specific type of kidney damage known as glomerulonephritis. In the context of Granulomatosis with Polyangiitis (GPA), red cell casts are particularly relevant due to the autoimmune inflammation affecting the glomeruli—the tiny filtering units in the kidneys. When these glomeruli become inflamed, red blood cells can leak into the urine. Red cell casts are formed when these red blood cells clump together within the kidney tubules, creating cylindrical structures. The presence of red cell casts in the urine, along with hematuria (blood in the urine), is a significant sign of kidney involvement and is often seen in conditions like GPA with rapidly progressive glomerulonephritis. Monitoring the urine for red cell casts is an important aspect of assessing kidney function and guiding the management of renal complications in GPA. Individuals with GPA experiencing symptoms such as hematuria and red cell casts should seek prompt medical attention for a comprehensive evaluation and appropriate intervention.


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