{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T14:25:38Z","timestamp":1771511138346,"version":"3.50.1"},"reference-count":12,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,6,17]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:p>A 22-year-old female patient was admitted to hospital after being referred from the oral medicine clinic where she had been seen for persistent gingivitis and mouth ulcers. She described an insidious history of persistent fevers, dry cough and unexplained weight loss over 4\u20136 weeks. Imaging showed extensive bilateral pulmonary nodules with mediastinal lymphadenopathy and two lesions in the pancreas. MRI revealed these lesions to be well-defined fluid-filled cysts in the tail of the pancreas, without features of malignancy. Core biopsies taken from her lung nodules demonstrated features of vasculitis with granulomata. This was consistent with her positive immunology for c-antinuclear cytoplasmic antibodies and proteinase-3, which were sent after her fever failed to settle with antibiotic treatment. In keeping with a diagnosis of vasculitis, the patient showed a significant clinical and biochemical response to intravenous methylprednisolone and high-dose daily prednisolone thereafter.<\/jats:p>","DOI":"10.1136\/bcr-2018-228693","type":"journal-article","created":{"date-parts":[[2019,7,9]],"date-time":"2019-07-09T06:10:38Z","timestamp":1562652638000},"page":"e228693","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Granulomatosis polyangiitis"],"prefix":"10.1136","volume":"12","author":[{"given":"Mustafa","family":"Sowida","sequence":"first","affiliation":[{"name":"Birmingham Heartlands Hospital, University Hospital Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,7,8]]},"reference":[{"key":"2025082709244642000_12.7.e228693.1","first-page":"267","article-title":"Pancreatic mass as an initial presentation of severe Wegener\u2019s granulomatosis","volume":"26","author":"Valerieva","year":"2013","journal-title":"Ann Gastroenterol"},{"key":"2025082709244642000_12.7.e228693.2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.amjmed.2006.08.016","article-title":"ANCA Are Detectable in Nearly All Patients with Active Severe Wegener\u2019s Granulomatosis","volume":"120","author":"Finkielman","year":"2007","journal-title":"Am J Med"},{"key":"2025082709244642000_12.7.e228693.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2012.08.006"},{"key":"2025082709244642000_12.7.e228693.4","first-page":"2571","article-title":"Risk of ovarian failure and fertility after intravenous cyclophosphamide. 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