{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T09:04:24Z","timestamp":1784624664260,"version":"3.55.0"},"reference-count":9,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Granulomatosis with polyangiitis (GPA) is a necrotizing granulomatous vasculitis affecting predominantly small vessels, typically associated with PR3-ANCA positivity. Central nervous system involvement beyond cranial nerve palsies is rare, with intracerebral granulomas being exceptionally rare and lacking specific imaging characteristics, often mimicking malignancies or other intracranial pathologies. This significantly complicates the diagnostic process, particularly in the absence of active systemic disease. We report a case of a 71-year-old woman in whom neurological symptoms and magnetic resonance imaging revealed intracerebral granulomas and led to the diagnosis of GPA. Early recognition of tumor-like brain lesions in GPA and prompt initiation of immunosuppressive and anti-edematous therapy are crucial to prevent progression and potentially life-threatening compressive complications.<\/jats:p>","DOI":"10.3390\/diagnostics16142277","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:14:27Z","timestamp":1784621667000},"page":"2277","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Uncommon Territory: Multifocal Tumor-like Brain Lesions in Granulomatosis with Polyangiitis"],"prefix":"10.3390","volume":"16","author":[{"given":"Ana","family":"Petkovic","sequence":"first","affiliation":[{"name":"Center for Radiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Drazic","sequence":"additional","affiliation":[{"name":"Clinic of Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Jovanovic","sequence":"additional","affiliation":[{"name":"Center for Radiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7596-4731","authenticated-orcid":false,"given":"Snezana","family":"Arandjelovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic of Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Plavsic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic of Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0982-2572","authenticated-orcid":false,"given":"Rada","family":"Miskovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic of Allergy and Immunology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Potentas-Policewicz, M., and Fijolek, J. (2024). Granulomatosis with polyangiitis: Clinical characteristics and updates in diagnosis. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1369233"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1002\/art.40577","article-title":"Epidemiology and Outcomes of Granulomatosis with Polyangiitis in Pediatric and Working-Age Adult Populations in the United States: Analysis of a Large National Claims Database","volume":"70","author":"Panupattanapong","year":"2018","journal-title":"Arthritis Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Jazayeri, S.B., Rahimian, A., Ahadi, M.S., Tavakolpour, S., and Alesaeidi, S. (2022). Neurologic Involvement in Granulomatosis with Polyangiitis: A Comparative Study. Biol. Life Sci. Forum, 19.","DOI":"10.3390\/IECBS2022-13963"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1002\/art.41773","article-title":"2021 American College of Rheumatology\/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis","volume":"73","author":"Chung","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1093\/rheumatology\/keu336","article-title":"Central nervous system involvement of granulomatosis with polyangiitis: Clinical\u2013radiological presentation distinguishes different outcomes","volume":"54","author":"Terrier","year":"2015","journal-title":"Rheumatology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"477","DOI":"10.46497\/ArchRheumatol.2022.9335","article-title":"Remote intracranial granulomas in granulomatosis with polyangiitis","volume":"37","author":"Phatak","year":"2022","journal-title":"Arch. Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"P1.2-032","DOI":"10.1212\/WNL.92.15_supplement.P1.2-032","article-title":"Brain mass dilemma\u2014Rare presentation of ANCA-negative granulomatosis with polyangiitis","volume":"92","author":"Salazar","year":"2019","journal-title":"Neurology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1136\/annrheumdis-2021-221795","article-title":"2022 American College of Rheumatology\/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis","volume":"81","author":"Robson","year":"2022","journal-title":"Ann. Rheum. Dis."},{"key":"ref_9","first-page":"541","article-title":"Severe CNS manifestations as the clinical hallmark in generalized Wegener\u2019s granulomatosis consistently negative for antineutrophil cytoplasmic antibodies (ANCA): A report of three cases and a review of the literature","volume":"19","author":"Arlt","year":"2001","journal-title":"Clin. Exp. 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