{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:06:46Z","timestamp":1771481206724,"version":"3.50.1"},"reference-count":40,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,2,5]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>Granulomatosis with polyangiitis (GPA), a subtype of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), is a systemic inflammatory disease that typically affects the respiratory tract and kidneys. However, atypical pancreatic manifestations have been reported, which may present clinically as acute pancreatitis or exocrine insufficiency, and radiologically as pancreatic enlargement or pseudotumour.<\/jats:p>\n                  <jats:p>A female in her 40s presented with nasal crusting and epistaxis. She subsequently developed fever, weight loss, haemoptysis, bilateral pulmonary nodules and a pancreatic tail mass. Pancreatic biopsy revealed caseating granulomatous inflammation, and antitubercular therapy was commenced.<\/jats:p>\n                  <jats:p>On developing haematuria and proteinuria, proteinase 3-ANCA testing and renal biopsy confirmed AAV. Treatment with rituximab and high-dose corticosteroids led to clinical improvement and radiological regression of both pulmonary and pancreatic lesions, consistent with systemic GPA involvement.<\/jats:p>\n                  <jats:p>This case highlights the importance of considering systemic inflammatory disease, alongside infective and malignant aetiologies, when evaluating pancreatic masses or focal pancreatitis with constitutional symptoms and multiorgan involvement.<\/jats:p>","DOI":"10.1136\/bcr-2025-270793","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T05:15:15Z","timestamp":1771478115000},"page":"e270793","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Tuberculosis or vasculitis? Granulomatous inflammation of the pancreatic tail as an atypical presentation of granulomatosis with polyangiitis"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5160-2552","authenticated-orcid":false,"given":"Matthew","family":"Whallett","sequence":"first","affiliation":[{"name":"Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aimen","family":"Ayaz","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy","family":"Hagan","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vandana","family":"Sagar","sequence":"additional","affiliation":[{"name":"Gastroenterology Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"2026021821150719000_19.2.e270793.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2014.08.017"},{"key":"2026021821150719000_19.2.e270793.2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223764"},{"key":"2026021821150719000_19.2.e270793.3","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/j.lpm.2012.06.007","article-title":"Granulomatosis with polyangiitis (Wegener\u2019s granulomatosis)","volume":"41","author":"Karras","year":"2012","journal-title":"Presse Med"},{"key":"2026021821150719000_19.2.e270793.4","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2024.1369233","article-title":"Granulomatosis with polyangiitis: clinical characteristics and updates in diagnosis","volume":"11","author":"Potentas-Policewicz","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"2026021821150719000_19.2.e270793.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199711203372106"},{"key":"2026021821150719000_19.2.e270793.6","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.3949\/ccjm.79.s3.04","article-title":"Upper airway manifestations of granulomatosis with polyangiitis","volume":"79 Suppl 3","author":"Alam","year":"2012","journal-title":"Cleve Clin J Med"},{"key":"2026021821150719000_19.2.e270793.7","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1038\/nrneph.2013.225","article-title":"Treatment of ANCA-associated vasculitis","volume":"10","author":"Sch\u00f6nermarck","year":"2014","journal-title":"Nat Rev Nephrol"},{"key":"2026021821150719000_19.2.e270793.8","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00120214"},{"key":"2026021821150719000_19.2.e270793.9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jctube.2017.02.001","article-title":"Histopathologic review of granulomatous inflammation","volume":"7","author":"Shah","year":"2017","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"key":"2026021821150719000_19.2.e270793.10","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s00296-023-05419-x","article-title":"Coexistence of IgG4-related disease and ANCA-associated vasculitis: case report and review of the literature","volume":"44","author":"Korkmaz","year":"2024","journal-title":"Rheumatol Int"},{"key":"2026021821150719000_19.2.e270793.11","doi-asserted-by":"publisher","DOI":"10.1080\/14397595.2020.1859710"},{"key":"2026021821150719000_19.2.e270793.12","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1007\/s10067-019-04568-4","article-title":"Uncommon presentations in ANCA vasculitis: clinical characteristics and outcomes","volume":"38","author":"Katikineni","year":"2019","journal-title":"Clin Rheumatol"},{"key":"2026021821150719000_19.2.e270793.13","first-page":"300","article-title":"Acute pancreatitis as the first presentation of Wegener\u2019s granulomatosis","volume":"9","author":"Abu-Hilal","year":"2008","journal-title":"JOP"},{"key":"2026021821150719000_19.2.e270793.14","doi-asserted-by":"crossref","DOI":"10.14309\/crj.0000000000000986","article-title":"Acute Pancreatitis as a First Presentation of Granulomatosis With Polyangiitis","volume":"10","author":"Youssef","year":"2023","journal-title":"ACG Case Rep J"},{"key":"2026021821150719000_19.2.e270793.15","doi-asserted-by":"crossref","first-page":"e85","DOI":"10.1097\/MPA.0000000000001944","article-title":"Pancreatitis as the Leading Manifestation of Granulomatosis With Polyangiitis","volume":"50","author":"Garbe","year":"2021","journal-title":"Pancreas"},{"key":"2026021821150719000_19.2.e270793.16","first-page":"167","article-title":"Acute pancreatitis as a rare initial manifestation of Wegener\u2019s granulomatosis. 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