{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:45:25Z","timestamp":1791539125991,"version":"4.3.4"},"reference-count":16,"publisher":"BMJ","issue":"6696","license":[{"start":{"date-parts":[[1989,8,12]],"date-time":"1989-08-12T00:00:00Z","timestamp":618883200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1989,8,12]]},"abstract":"<jats:p>The standard description of Wegener's granulomatosis emphasises renal failure and thus a distorted impression may be given. Subacute and even chronic cases occur, and in these patients the presentation is varied and often insidious, leading to delay in diagnosis. Twenty two such patients (13 women and nine men) with a mean age of 44 years were seen in our connective tissue disease clinic. The mean duration of symptoms before diagnosis was 3.6 years and the mean duration of disease 5.9 years (19 years in one patient). All patients had malaise and ear, nose, and throat symptoms, and most had joint pains. Impaired renal function was seen in seven patients only. Tissue biopsy was diagnostic in half of the patients, and appreciably high titres of antineutrophil cytoplasmic antibodies were detected in only nine of 18 patients in whom these were measured. The most useful investigations were neutrophil counts, chest radiographs, and computed tomography of the sinuses and orbits. The most effective treatment was with intravenous pulses of cyclophosphamide. No deaths occurred. At the time of writing two patients were in remission and no longer being treated and 18 patients were in partial remission on continued treatment. Patients with subacute forms of Wegener's granulomatosis present with a variety of clinical features and the insidious presentation often leads to delay in diagnosis. A history of ear, nose, and throat symptoms was universal in our patients.<\/jats:p>","DOI":"10.1136\/bmj.299.6696.419","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"419-422","source":"Crossref","is-referenced-by-count":50,"title":["Ear, nose, and throat symptoms in subacute Wegener's granulomatosis."],"prefix":"10.1136","volume":"299","author":[{"given":"D. P.","family":"D'Cruz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Baguley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. A.","family":"Asherson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. R.","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1989,8,12]]},"reference":[{"key":"ref_1","first-page":"168","article-title":"Wegener's granulomatosis","volume":"17","author":"Fahey, J.L.; Leonard, E.; Churg, J.; Godman, G.","year":"1954","unstructured":"Fahey JL, Leonard E, Churg J, Godman G. Wegener's granulomatosis. AmJMed 1954;17:168-79.","journal-title":"AmJMed"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"513","DOI":"10.7326\/0003-4819-81-4-513","article-title":"Wegener's granulomatosis","volume":"81","author":"Wolff, S.M.; Fauci, A.S.; Horn, R.G.; Dale, D.C.","year":"1974","unstructured":"Wolff SM, Fauci AS, Horn RG, Dale DC. Wegener's granulomatosis. Ann Intern Med 1974;81:513-25.","journal-title":"Ann Intern Med"},{"issue":"65","key":"ref_3","first-page":"553","article-title":"Ocular changes in limited forms of Wegener's granulomatosis","volume":"1981","unstructured":"Spalton DJ, Graham EM, Page NGR, Sanders MD. Ocular changes in limited forms of Wegener's granulomatosis. Br] Ophthalmol 1981,65:553-63.","journal-title":"Br] Ophthalmol"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1001\/jama.1975.03260080030015","article-title":"Limited form of Wegener's granulomatosis. Eye involvement as a major sign","volume":"233","author":"Coutu, R.E.; Klein, M.; Lessell, S.; Friedman, E.; Snider, G.L.","year":"1975","unstructured":"Coutu RE, Klein M, Lessell S, Friedman E, Snider GL. Limited form of Wegener's granulomatosis. Eye involvement as a major sign. JAM-I 1975;233:868-7 1.","journal-title":"JAM-I"},{"key":"ref_5","first-page":"949","article-title":"Rheumatic manifestations of Wegener's granulomatosis","volume":"14","author":"Noritake, D.T.; Weiner, SR, Bassett; LW, Paulus; HE, Weisbart; R.","year":"1987","unstructured":"Noritake DT, Weiner SR, Bassett LW, Paulus HE, Weisbart R. Rheumatic manifestations of Wegener's granulomatosis. J Rheumatol 1987;14:949-5 1.","journal-title":"J Rheumatol"},{"issue":"297","key":"ref_6","first-page":"352","article-title":"Recurrent otitis media and pulmonary infiltrates as presenting features in Wegener's granulomatosis","volume":"1988","author":"Ridley, M.G.; Wolfe, C.S.; Asherson, R.A.; Hughes, G.R.V.","unstructured":"Ridley MG, Wolfe CS, Asherson RA, Hughes GRV. Recurrent otitis media and pulmonary infiltrates as presenting features in Wegener's granulomatosis. BrMedJ7 1988;297:352-3.","journal-title":"BrMedJ7"},{"key":"ref_7","first-page":"497","article-title":"Limited forms of angiitis and granulomatosis of Wegener's type","volume":"41","author":"Carrington, C.B.; Liebow, A.A.","year":"1966","unstructured":"Carrington CB, Liebow AA. Limited forms of angiitis and granulomatosis of Wegener's type. Am7Med 1966;41:497-527.","journal-title":"Am7Med"},{"issue":"208","key":"ref_8","first-page":"435","article-title":"Wegener's granulomatosis: observations on 18 patients with severe renal disease","volume":"52","author":"Pinching, A.J.; ILockwood, C.M.; Pussell, B.A.","year":"1983","unstructured":"Pinching AJ, ILockwood CM, Pussell BA, et al. Wegener's granulomatosis: observations on 18 patients with severe renal disease. Q 7 Med 1983. Autumn;52(208):435-60."},{"key":"ref_9","first-page":"76","article-title":"Wegener's grantilomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years","volume":"98","author":"Fauci, A.S.; Haynes, B.F.; Katz, P.; Wolff, S.M.","year":"1983","unstructured":"Fauci AS, Haynes BF, Katz P, Wolff SM. Wegener's grantilomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann InternMed 1983;98:76-85."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/00005792-198403000-00001","article-title":"Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome","volume":"63","author":"Lanham, J.G.; Elkon, K.B.; Pusey, C.D.; Hughes, G.R.V.","year":"1984","unstructured":"Lanham JG, Elkon KB, Pusey CD, Hughes GRV. Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine 1984;63:65-81.","journal-title":"Medicine"},{"key":"ref_11","first-page":"716","article-title":"Association of alkaline phosphatase with an autoantigen recognised by circulating anti-neutrophil antibodies in systemic vasculitis","volume":"i:","author":"Lockwood, C.M.; Bakes, D.; Jones, S.; Whitaker, K.B.; Moss, D.W.; Savage, C.O.S.","year":"1987","unstructured":"Lockwood CM, Bakes D, Jones S, Whitaker KB, Moss DW, Savage COS. Association of alkaline phosphatase with an autoantigen recognised by circulating anti-neutrophil antibodies in systemic vasculitis. Lancet 1987;i: 716-20.","journal-title":"Lancet"},{"key":"ref_12","first-page":"1389","article-title":"Prospective study of radioimmunoassay for antibodies against neutrophil cytoplasm in diagnosis of systemic vasculitis","volume":"i:","author":"Savage, C.O.S.; Jones, S.; Winearls, C.G.; Marshall, P.D.; Lockwood, C.M.","year":"1987","unstructured":"Savage COS, Jones S, Winearls CG, Marshall PD, Lockwood CM. Prospective study of radioimmunoassay for antibodies against neutrophil cytoplasm in diagnosis of systemic vasculitis. Lancet 1987;i: 1389-93.","journal-title":"Lancet"},{"key":"ref_13","first-page":"85","article-title":"Antibodies to neutrophil cvtoplasmic antigen in systemic sasculitis","volume":"ii:","author":"Venning, M.C.; Arfeen, S.; Bird, A.E.","year":"1987","unstructured":"Venning MC, Arfeen S, Bird AE. Antibodies to neutrophil cvtoplasmic antigen in systemic sasculitis. Lancet 1987;ii:85(0.","journal-title":"Lancet"},{"issue":"1","key":"ref_14","first-page":"33","article-title":"Antineutrophil cytoplasmic antibodies (ANCA) in limited Wegener's disease","volume":"27","author":"Luqmani, R.A.; Beaman, M.; Shenot, P.M.; Adu, D.; Michacl, J.; Bacon, P.A.","year":"1988","unstructured":"Luqmani RA, Beaman M, Shenot PM, Adu D, Michacl J, Bacon PA. Antineutrophil cytoplasmic antibodies (ANCA) in limited Wegener's disease. Brj Rheumatol 1988;27(suppl 1):33.","journal-title":"Brj Rheumatol"},{"key":"ref_15","first-page":"501","article-title":"Wegener's granulomatosis. Long term follow-up of patients treated with cyclophosphamide","volume":"18","author":"Reza, M.J.; Dornfeld, L.; Goldberg, L.S.; Bluestone, R.; Pearson, C.M.","year":"1975","unstructured":"Reza MJ, Dornfeld L, Goldberg LS, Bluestone R, Pearson CM. Wegener's granulomatosis. Long term follow-up of patients treated with cyclophosphamide. Arthritis Rheum 1975;18:501-6.","journal-title":"Arthritis Rheum"},{"key":"ref_16","first-page":"39","article-title":"Treatment of Wegener's granulomatosis with cyclophosphamide: an outcome analysis","volume":"31","author":"Weiner, SR, Paulus; H.E.","year":"1988","unstructured":"Weiner SR, Paulus HE. Treatment of Wegener's granulomatosis with cyclophosphamide: an outcome analysis. 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