Vasculitis of the Sinuses: Rare but Serious Cause of Chronic Sinus Disease

Vasculitis of the Sinuses: Rare but Serious Cause of Chronic Sinus Disease

If you’ve had “sinus infections” for months—and antibiotics aren’t helping—it may not be an infection at all. In a small number of people, chronic nasal and sinus symptoms are driven by an autoimmune problem that inflames blood vessels. Over time, that inflammation can injure delicate nasal tissue and (in some cases) involve other organs if it isn’t recognized and treated.

One of the most important conditions in this category is granulomatosis with polyangiitis (GPA). It often begins with ENT symptoms and can look a lot like routine sinusitis early on. (Mayo Clinic)

If you’re dealing with persistent symptoms that don’t fit the usual pattern of chronic sinusitis, this overview can help you understand what vasculitis of the sinuses is, what “red flags” to watch for, and how ENT and rheumatology teams typically evaluate it.

What Is Vasculitis of the Sinuses?

The basics—what “vasculitis” means

Vasculitis means inflammation of blood vessels. A helpful way to picture it: blood vessels are like a neighborhood’s water pipes. When those pipes become inflamed and narrowed, tissues downstream may not get the steady, healthy flow they need.

In the nose and sinuses, reduced healthy blood flow plus ongoing immune irritation can contribute to swelling, tenderness, crusting, sores/ulcers, and—over time—tissue damage. Because the nose is constantly exposed to dry air, allergens, and everyday germs, even small injuries can feel dramatic and keep repeating.

The upper airway (nose, sinuses, throat) is a common area for symptoms to show up early because the lining is sensitive and constantly exposed to irritants.

GPA (Granulomatosis with Polyangiitis) and the sinuses

GPA is an autoimmune type of vasculitis that can involve the nose, sinuses, ears, lungs, and kidneys. ENT symptoms are very common and can mimic allergies or recurrent infections—especially at the beginning. (NCBI Bookshelf; Johns Hopkins Vasculitis Center; Vasculitis Foundation)

A typical early pattern can sound deceptively ordinary: “It feels like my sinuses are always inflamed,” or “I keep getting put on antibiotics, but it never truly clears.” That’s one reason vasculitis of the sinuses can be missed—it may initially look like everyday sinus trouble until more specific clues emerge.

Summary: If chronic “sinus infections” don’t behave like your usual sinusitis, vasculitis deserves a closer look.

Why It’s Often Mistaken for “Normal” Chronic Sinusitis

Symptom overlap with sinus infections and allergies

Many symptoms overlap with more common sinus conditions: congestion and nasal blockage; postnasal drip; facial pressure; drainage; reduced sense of smell. If you’ve ever had allergic rhinitis or chronic sinusitis, you know the routine: congestion worsens, pressure builds, you try sprays or antibiotics, and you hope it finally “breaks.” In autoimmune-related inflammation, that familiar cycle can happen—except the root cause isn’t primarily bacterial.

Because the inflammation in autoimmune sinusitis isn’t primarily bacterial, chronic sinusitis not responding to antibiotics can be a key clue that something else is going on.

For a broader overview of typical patterns, see our guide to chronic sinusitis: https://sleepandsinuscenters.com/chronic-sinusitis

The key difference—tissue damage and systemic clues

Unlike routine inflammation, vasculitis may lead to ulcerations, heavy crusting, bleeding, and destructive changes in the nasal structures over time. (ScienceDirect) Clinicians often describe the mucosal changes seen in vasculitis-related nasal disease as more “erosive” or destructive compared to the swelling typical of standard sinusitis. That destructive pattern is one reason persistent, unusual symptoms get attention—especially when symptoms extend beyond the nose and sinuses.

Summary: When symptoms are persistent, erosive, or spread to other organs, it’s not “just sinusitis” anymore.

Symptoms of Sinus Vasculitis (Patient-Friendly Checklist)

Educational note (not a diagnosis): The checklist below can’t diagnose GPA or any autoimmune condition. Symptoms overlap with many other issues. A clinician’s evaluation is needed to understand the cause.

Common sinonasal symptoms seen in GPA

People with GPA may experience: persistent nasal blockage/congestion; thick discharge (sometimes blood-tinged); crusting that keeps returning; nasal/sinus pain or pressure that may not match what a scan shows; reduced sense of smell; recurrent “sinus infections” despite standard therapy. These are often described as granulomatosis with polyangiitis (GPA) sinus symptoms because they’re so common in the upper airway. (Mayo Clinic; Johns Hopkins; NCBI Bookshelf)

A concrete example: someone may report that they can rinse out large crusts daily, yet the nose still feels blocked an hour later. Or they may notice a constant “raw” sensation that doesn’t behave like their usual seasonal allergies.

Red-flag nasal symptoms that deserve faster evaluation

Symptoms that may raise concern for more than routine sinusitis include: frequent nosebleeds; painful sores/ulcers inside the nose; worsening crusting with an erosive feeling; a new whistling sound when breathing (can happen with a septal perforation); nasal shape changes such as bridge collapse (saddle nose deformity). Destructive nasal changes have been specifically described in GPA-related sinonasal disease. (OAE Publishing) Symptoms such as frequent nosebleeds, painful ulcers, or nasal shape changes should prompt timely medical evaluation.

Symptoms outside the sinuses (important clue)

Because GPA can affect more than the nose, additional symptoms may include: persistent cough, shortness of breath, wheezing, or coughing blood; blood in urine, foamy urine, or swelling (possible kidney involvement); fatigue, fevers, weight loss; ear fullness or hearing changes, hoarseness; eye redness/pain or vision changes. (Mayo Clinic; Johns Hopkins; NCBI Bookshelf)

One practical red flag is symptom spread: sinus problems plus new lung symptoms, urinary changes, or eye pain should prompt timely medical evaluation, even if the nasal symptoms alone seem manageable.

Summary: Patterns that include crusting, bleeding, ulcers, and symptoms beyond the sinuses deserve prompt evaluation.

What Causes Vasculitis in the Sinuses?

Autoimmune causes (most common in this context)

When clinicians discuss vasculitis of the sinuses, GPA is often the top concern due to how frequently it involves the nose and sinuses. Other inflammatory/autoimmune diseases can also involve ENT tissues, but GPA is a key “must not miss” diagnosis because it can affect vital organs. You may hear a clinician say something like: most sinusitis is common and straightforward—but we stay alert for the uncommon causes when the course is unusual. That’s the role of careful pattern recognition, not panic.

What we don’t fully know

It’s not contagious; it’s not caused by poor hygiene; it appears to involve immune system misfiring and specific triggers are not fully understood. (Vasculitis Foundation)

Summary: GPA is uncommon but important—especially when chronic sinus symptoms don’t respond as expected.

Complications: Why Early Diagnosis Matters

Local (nose/sinus) complications

Ongoing inflammation can lead to scarring and structural damage, including: chronic obstruction and scarring; septal perforation (a hole in the nasal septum); saddle nose deformity (collapse of the nasal bridge); secondary infections due to a damaged lining. (OAE Publishing) Because inflamed tissue is more fragile, repeated injury can impair normal healing and lead to long-term changes.

Whole-body complications (the “serious” part)

In some cases, GPA can progress beyond the sinuses and cause: lung disease (including bleeding); kidney inflammation that can threaten kidney function if untreated; severe disease complications without proper treatment. (Mayo Clinic; NCBI Bookshelf; Johns Hopkins) This systemic risk is why clinicians don’t treat GPA as “just a sinus problem,” even when the first symptoms are entirely in the nose.

Summary: Early recognition and treatment help prevent both local damage and serious systemic complications.

How Doctors Diagnose Vasculitis of the Sinuses

Step 1 — Detailed history + nasal exam/endoscopy

An ENT clinician may ask detailed questions (symptoms, timeline, response to antibiotics, nosebleeds, crusting) and examine the nasal passages. With nasal endoscopy, they may look for: crusting and thick secretions; ulcerations or fragile tissue; signs of septal damage. If it helps, bring a short timeline to your appointment (when symptoms started, how many antibiotic courses you’ve had, and what actually improved). Even a few bullet points can make patterns clearer.

Step 2 — Imaging (CT/MRI)

Imaging helps clarify what’s happening beneath the surface: CT is often used to evaluate sinus anatomy, inflammation patterns, and bony changes; MRI may be used in certain situations to assess soft tissue concerns or complications. Imaging can support concern for autoimmune sinusitis, although scans alone may not be definitive. (NCBI Bookshelf; ScienceDirect) In other words, a CT may show inflammation—but the type of inflammation and the overall story (including symptoms and exam findings) are what guide next steps.

Step 3 — Blood tests (including ANCA)

A common blood test in suspected GPA is the ANCA test. In simple terms, ANCA looks for certain antibodies that can be associated with GPA and related conditions. Important nuance: ANCA can be very helpful, but it isn’t perfect—some people with GPA can have a negative ANCA result, so clinicians interpret it alongside symptoms, imaging, and other findings. (NCBI Bookshelf)

Step 4 — Biopsy (often the key)

A tissue sample can sometimes confirm vasculitis and/or granulomatous inflammation. Depending on the situation, biopsy may be taken from the nose/sinuses or another affected site. If your clinician recommends this step, our overview of what to expect from a sinus biopsy may be helpful: https://sleepandsinuscenters.com/blog/what-happens-during-a-sinus-biopsy

Summary: Diagnosis weaves together symptoms, endoscopy, imaging, labs, and often biopsy—not any single test alone.

Treatment Options (What Patients Can Expect)

The main goal: stop inflammation fast and protect organs. Treatment is individualized and often involves coordination between ENT and rheumatology—with the primary goal of calming inflammation and protecting organs.

Treatment is often discussed in phases: induction (getting active disease under control); maintenance (keeping disease quiet and preventing flares). It can help to ask your care team, “Are we in induction or maintenance right now?” That one question often clarifies why medication choices and monitoring plans may change over time.

Medications used for GPA-related sinus vasculitis

Plans may include: corticosteroids to reduce inflammation quickly; immune-modulating or immunosuppressive medications; in some cases, biologic therapies. Because these medicines can affect the immune system, monitoring with follow-up visits and lab work is a major part of care. (Mayo Clinic; Johns Hopkins; Vasculitis Foundation)

ENT-focused care for nasal/sinus symptoms

Supportive ENT care may focus on comfort and reducing local inflammation, such as: saline irrigations to help clear crusting; topical therapies when appropriate; treating secondary bacterial infections when they’re truly present (not every flare needs antibiotics). Many patients find it reassuring to hear: symptom relief matters, even while the systemic treatment is being optimized. Local care can reduce pain, bleeding, and crust burden while the underlying inflammation is addressed.

When surgery is considered—and when it isn’t

Sinus procedures may help with blockage or complications for selected patients, but surgery does not replace systemic treatment for vasculitis. Controlling inflammation first can improve healing and reduce risks, and operating too early may worsen local inflammation or impair healing. (ScienceDirect)

Summary: Medicines control the disease; ENT care supports comfort—surgery is reserved for select situations and timed carefully.

Lifestyle & Self-Care Tips (Safe, Practical, Patient-Friendly)

Daily comfort strategies

Gentle saline rinses using sterile or distilled water; humidifier use if dryness worsens crusting; avoiding smoke and strong chemical irritants when possible. A small, practical example: if crusting is severe, some people do better with more frequent gentle rinses rather than one aggressive rinse that irritates already-fragile tissue.

Infection-prevention basics (especially if immunosuppressed)

Hand hygiene and reasonable precautions around sick contacts; ask your clinician about recommended vaccines (flu, COVID, pneumonia as appropriate).

Medication safety habits

Avoid stopping steroids abruptly without clinician guidance; keep a simple symptom log (nosebleeds, crusting, breathing changes, urinary changes). This overview does not address special situations such as pregnancy or pediatric cases; ask your clinician for individualized guidance.

Summary: Small daily steps plus smart precautions can ease symptoms and reduce risks while treatment works.

When to See an ENT (or Seek Urgent Care)

Make an appointment soon if:

“Sinus infections” keep returning; symptoms persist despite appropriate therapy; new crusting, bleeding, or ulcers are developing. If you’re unsure what’s typical vs concerning, review common symptoms of sinus problems and bring your notes to your visit: https://sleepandsinuscenters.com/symptoms-of-sinus-problems

Seek urgent/emergency evaluation if:

Coughing up blood or severe shortness of breath; chest pain, severe weakness, or fainting; vision changes or severe eye pain; blood in urine or significant swelling. (Mayo Clinic; Johns Hopkins)

Summary: If symptoms are persistent or severe—especially beyond the nose—don’t wait to get evaluated.

FAQs

Can vasculitis cause chronic sinusitis?

Yes. Vasculitis of the sinuses, especially from GPA, can inflame and damage nasal/sinus tissues and mimic chronic sinusitis. (Mayo Clinic; NCBI Bookshelf)

What are the “red flags” that chronic sinusitis might be autoimmune?

Recurring crusting, nosebleeds, ulcers, symptoms of septal perforation, saddle nose deformity, and symptoms outside the nose (lungs, kidneys, eyes) can be clues that evaluation for autoimmune sinusitis is appropriate. (OAE Publishing)

Is GPA life-threatening?

It can be if untreated—especially when kidneys or lungs are involved. Early diagnosis and treatment have significantly improved outcomes. (Mayo Clinic; Johns Hopkins; NCBI Bookshelf)

Does a positive ANCA test confirm GPA?

A positive ANCA can strongly support the diagnosis in the right clinical setting, but clinicians typically combine it with symptoms, imaging, and sometimes biopsy. (NCBI Bookshelf)

Can antibiotics cure vasculitis-related sinus symptoms?

Antibiotics may help only if there is a secondary bacterial infection. They do not treat the underlying autoimmune inflammation.

Will my nose go back to normal after treatment?

Many symptoms can improve with treatment. However, structural damage—such as a septal perforation or saddle nose deformity—may not fully reverse and may require specialized evaluation. Earlier treatment can help prevent progression. (ScienceDirect; OAE Publishing; Johns Hopkins)

Key Takeaways

Vasculitis of the sinuses is rare but can be serious—especially when caused by GPA; it may look like routine sinusitis until symptoms don’t improve or become destructive (crusting, bleeding, ulcers, structural change); diagnosis often includes nasal exam/endoscopy, imaging, ANCA testing, and sometimes biopsy; treatment focuses on immune control plus ENT symptom care to prevent complications. (Mayo Clinic; NCBI Bookshelf; Vasculitis Foundation; Johns Hopkins)

Call to Action

If you’re dealing with persistent sinus symptoms—especially chronic sinusitis not responding to antibiotics or new nosebleeds/crusting—an ENT evaluation can help clarify what’s going on and whether referral to rheumatology is appropriate. To request a visit with Sleep and Sinus Centers of Georgia, you can schedule an appointment: https://sleepandsinuscenters.com/appointments

Note: If you’ve been “waiting it out” because symptoms seem like routine sinusitis, booking an appointment now can be a practical next step—especially if you’ve noticed bleeding, ulcers, or worsening crusting.

References

Mayo Clinic. Granulomatosis with polyangiitis (GPA) – Symptoms & causes. (Accessed 2025) https://www.mayoclinic.org/diseases-conditions/granulomatosis-with-polyangiitis/symptoms-causes/syc-20351088

NCBI Bookshelf. Granulomatosis with Polyangiitis. (2024) https://www.ncbi.nlm.nih.gov/books/NBK557827/

Vasculitis Foundation. Granulomatosis with Polyangiitis (GPA). (2024) https://vasculitisfoundation.org/education/vasculitis-types/granulomatosis-with-polyangiitis/

ScienceDirect. Article on sinonasal/ENT manifestations in GPA. (2024) https://www.sciencedirect.com/science/article/pii/S0385814624000415

OAE Publishing. Review on sinonasal disease/destructive changes in GPA. (2021) https://www.oaepublish.com/articles/2574-1209.2021.41

Johns Hopkins Vasculitis Center. Granulomatosis with Polyangiitis. (2021) https://www.hopkinsvasculitis.org/types-vasculitis/granulomatosis-with-polyangiitis/

Disclaimer

This article is for educational purposes only and is not medical advice. Please consult a qualified healthcare provider for diagnosis and treatment.