{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:59:15Z","timestamp":1787763555279,"version":"build-2784847793"},"reference-count":27,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,2,10]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>Granulomatosis with polyangiitis (GPA) is a rare necrotising small vessel vasculitis typically associated with oronasal, pulmonary and renal manifestations. Pancreatic disease is an exceedingly rare initial presentation and is associated with delayed diagnosis and rapid progression. We discuss a 66-year-old woman presenting with epigastric pain, elevated lipase and radiographic evidence of focal pancreatitis. She had no relevant medical history and no lithiasis seen on imaging. Pertinent findings include strawberry gingivitis, positive proteinase-antineutrophil cytoplasm antibody (98% specificity) and focal nodular parenchymal lung lesions on CT chest\u2014all of which are consistent with a diagnosis of GPA. She was promptly started on high-dose steroids which resulted in significant clinical and biochemical improvement. Cyclophosphamide was added once biopsy confirmed the absence of malignancy. In order to optimise the clinical outcomes of GPA, physicians must keep a wide differential and high index of suspicion in the setting of unexplained pancreatitis with systemic features.<\/jats:p>","DOI":"10.1136\/bcr-2020-241033","type":"journal-article","created":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T10:58:09Z","timestamp":1614682689000},"page":"e241033","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Granulomatosis with polyangiitis presenting as pancreatic disease"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9177-8744","authenticated-orcid":false,"given":"Jessie Jia","family":"Tao","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0931-7851","authenticated-orcid":false,"given":"Arnav","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9457-9751","authenticated-orcid":false,"given":"Ari Benjamin","family":"Cuperfain","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6287-9549","authenticated-orcid":false,"given":"Christian","family":"Pagnoux","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,2]]},"reference":[{"key":"2025082802011269000_14.3.e241033.1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-98-1-76"},{"key":"2025082802011269000_14.3.e241033.2","doi-asserted-by":"publisher","DOI":"10.1097\/01.md.0000158825.87055.0b"},{"key":"2025082802011269000_14.3.e241033.3","first-page":"167","article-title":"Acute pancreatitis as a rare initial manifestation of Wegener's granulomatosis. 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