Some aspects of therapy in the non-healing granulomas of Wegener and Stewart.

The non-healing granulomas of Wegener and Stewart (Wegener's granuloma and lethal midline granuloma) have been recognized since 1897. A mainstay of therapy has been the empirical application of treatments based upon theoretical or pathological assumption, and we are only slightly closer to classifying these diseases. Between 1967 and 1975 eight patients with non-healing granuloma of Wegener's type, and one patient with non-healing granuloma of Stewart's type, presented to the Otolaryngology Service of the conjoined McGill University Hospitals. All received corticosteriods and all those with the Wegener type of granuloma received azathioprine (Immuran). Four patients are alive and well today from five months to eight years and 10 months after starting therapy. Some aspects of the changing historical, clinical, pathologic, and therapeutic indices of these diseases are presented, with our experiences in these areas.