Table 2 The patient’s diagnostic and treatment process in chronological order

First diagnosis of GPA diagnosed by glomerulon ephritis

Permanent medication with prednisolone and cyclosporine. Development of a steroid-associated osteoporosis treated intravenously with denosumad. Over the time developing pulmonary emphysema, Raynaud’s phenomenon, sinusitis maxilliaris and orbital pseudotumor.

Development of gingival hyperlpasia. In the following periodontal theraphy without benefit by her dentist. Thus reffered to periodontist. Recommendation for gingivectomy, transfer to Department of Cranio-Maxillofacial Surgery, University Hospital Münster. Biospsy from hyperplastic gingivitis taken

Ambulant follow-up in the Department of Cranio-Maxillofacial Surgery, University Hospital Münster.

Suspiction of recurrence of GPA by increasing (c)-ANCA and clinical signs of recurrence. Stationary therapie at Internal Medicine Clinic, University Hospital Münster. In the following 375 mg/m² rituximab weekly for a total of 4 doses, and prednisolone 10 mg/day.