{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:10:11Z","timestamp":1756311011467,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,2,2]]},"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:p>A 62-year-old man presented with excruciating joint pains, back stiffness and numbness of his hands and feet. Over the past 18 months, he had experienced similar episodes for which the diagnoses of bilateral carpal tunnel syndrome and lateral epicondylitis had been made. Physical examination revealed polyarticular arthritis affecting the shoulders, wrists and right knee. Palpable purpura overlying the calves and ankles was present. Laboratory tests showed markedly elevated erythrocyte sedimentation rate and C-reactive protein in the setting of negative blood and urine cultures. Rheumatoid factor and antinuclear antibodies were negative. Chest CT demonstrated bilateral pulmonary infiltrates. A punch biopsy of the rash showed leukocytoclastic vasculitis. Anti-proteinase-3 titers returned strongly positive. A diagnosis of granulomatosis with polyangiitis was made. Treatment with high-dose steroids, followed by rituximab resulted in normalisation of inflammatory markers with subsequent resolution of joint pains, rash and pulmonary infiltrates and improvement of neuropathic symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2018-227348","type":"journal-article","created":{"date-parts":[[2019,3,1]],"date-time":"2019-03-01T04:44:12Z","timestamp":1551415452000},"page":"bcr-2018-227348","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["\u2018Carpal tunnel syndrome\u2019 and \u2018tennis elbow\u2019 as prodromes for granulomatosis with polyangiitis (formerly Wegener\u2019s granulomatosis)"],"prefix":"10.1136","volume":"12","author":[{"given":"Christian","family":"Geier","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Columbia University, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Steed","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Columbia University, New York, New York, USA"},{"name":"Division of Rheumatology, James J Peters VA Medical Center, Bronx, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,2,28]]},"reference":[{"key":"2025082708473808000_12.2.bcr-2018-227348.1","doi-asserted-by":"publisher","DOI":"10.1002\/art.37715"},{"key":"2025082708473808000_12.2.bcr-2018-227348.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2009.03.001"},{"key":"2025082708473808000_12.2.bcr-2018-227348.3","doi-asserted-by":"publisher","DOI":"10.1186\/2052-1839-13-9"},{"key":"2025082708473808000_12.2.bcr-2018-227348.4","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.054593"},{"key":"2025082708473808000_12.2.bcr-2018-227348.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0909905"},{"key":"2025082708473808000_12.2.bcr-2018-227348.6","doi-asserted-by":"crossref","unstructured":"Harrison L , Mcnally J , Corbridge R . Granulomatosis with polyangiitis affecting the skull base and manifesting as spontaneous skull base osteomyelitis. BMJ Case Rep 2016;doi: 10.1136\/bcr-2015-21391.doi:10.1136\/bcr-2015-213912","DOI":"10.1136\/bcr-2015-213912"},{"key":"2025082708473808000_12.2.bcr-2018-227348.7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12903-016-0262-4","article-title":"Gingival hyperplasia as first sign of recurrence of granulomatosis with polyangiitis (Wegener\u2019s granulomatosis): case report and review of the literature","volume":"17","author":"Hanisch","year":"2016","journal-title":"BMC Oral Health"},{"key":"2025082708473808000_12.2.bcr-2018-227348.8","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000001088"},{"key":"2025082708473808000_12.2.bcr-2018-227348.9","doi-asserted-by":"crossref","first-page":"256","DOI":"10.5114\/reum.2017.71643","article-title":"Two clinical cases of granulomatosis with polyangiitis with isolated otitis media and mastoiditis","volume":"55","author":"Kukushev","year":"2017","journal-title":"Reumatologia"},{"key":"2025082708473808000_12.2.bcr-2018-227348.10","doi-asserted-by":"crossref","first-page":"319","DOI":"10.21037\/jss.2016.12.03","article-title":"Spinal cord compression from Wegener\u2019s granulomatosis: an unusual presentation","volume":"2","author":"Roy","year":"2016","journal-title":"J Spine Surg"},{"key":"2025082708473808000_12.2.bcr-2018-227348.11","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1007\/s00586-007-0318-x","article-title":"The upper thoracic spinal cord compression as the initial manifestation of Wegener\u2019s granulomatosis: a case report","volume":"16 Suppl 3","author":"Wang","year":"2007","journal-title":"Eur Spine J"},{"key":"2025082708473808000_12.2.bcr-2018-227348.12","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1097\/PHM.0000000000000562","article-title":"Vasculitic Mononeuritis Multiplex May Be Misdiagnosed as Carpal Tunnel Syndrome","volume":"96","author":"Ghazaei","year":"2017","journal-title":"Am J Phys Med Rehabil"},{"key":"2025082708473808000_12.2.bcr-2018-227348.13","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000010592","article-title":"Methylprednisolone and plasmapheresis are effective for life-threatening diffuse alveolar hemorrhage and gastrointestinal hemorrhage in granulomatosis with polyangiitis: A case report and literature review","volume":"97","author":"Ning","year":"2018","journal-title":"Medicine"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-227348","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:47:42Z","timestamp":1756309662000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-227348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2]]},"references-count":13,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,2,28]]},"published-print":{"date-parts":[[2019,2]]}},"alternative-id":["10.1136\/bcr-2018-227348"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-227348","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,2]]}}}