{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T11:43:15Z","timestamp":1788090195776,"version":"build-2803163510"},"reference-count":22,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Granulomatosis with polyangiitis (GPA) is an ANCA-associated vasculitis that often affects the respiratory tract and kidneys, while ocular involvement is less common and may delay diagnosis. Bilateral dacryoadenitis as an initial manifestation is particularly uncommon and can obscure early recognition. Case Presentation: A 24-year-old woman presented with recurrent epistaxis, headaches, and progressive bilateral eyelid swelling. MRI showed enlarged lacrimal glands consistent with granulomatous dacryoadenitis. Over the following weeks, she developed systemic symptoms and rapidly progressive renal impairment. Serology revealed positive c-ANCA and anti-PR3 antibodies, and HRCT demonstrated pulmonary nodules and ground-glass opacities. Renal biopsy confirmed necrotizing pauci-immune crescentic glomerulonephritis. Despite treatment with glucocorticoids, cyclophosphamide, and rituximab, renal recovery was incomplete, necessitating hemodialysis. Conclusions: This case illustrates bilateral dacryoadenitis as an early sign of GPA and emphasizes the need for prompt ANCA testing and renal evaluation. Early recognition is crucial to prevent irreversible kidney damage.<\/jats:p>","DOI":"10.3390\/reports9010025","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T11:01:14Z","timestamp":1768388474000},"page":"25","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["When Tears Signal Vasculitis: Bilateral Dacryoadenitis as the Initial Manifestation of Granulomatosis with Polyangiitis\u2014Case Report"],"prefix":"10.3390","volume":"9","author":[{"given":"Sylvia","family":"Kutsarova","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Medical University of Varna, 55 Marin Drinov St., 9002 Varna, Bulgaria"},{"name":"Clinic of Rheumatology, University Hospital \u201cSt. Marina\u201d EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1652-4648","authenticated-orcid":false,"given":"Tsvetoslav","family":"Georgiev","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical University of Varna, 55 Marin Drinov St., 9002 Varna, Bulgaria"},{"name":"Clinic of Rheumatology, University Hospital \u201cSt. Marina\u201d EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miroslava","family":"Benkova-Petrova","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical University of Varna, 55 Marin Drinov St., 9002 Varna, Bulgaria"},{"name":"Clinic of Nephrology, University Hospital \u201cSt. Marina\u201d EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandar","family":"Petrov","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical University of Varna, 55 Marin Drinov St., 9002 Varna, Bulgaria"},{"name":"Clinic of Nephrology, University Hospital \u201cSt. Marina\u201d EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hristo","family":"Popov","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical University of Varna, 55 Marin Drinov St., 9002 Varna, Bulgaria"},{"name":"Clinic of General and Clinical Pathology, University Hospital \u201cSt. Marina\u201d EAD, 1 Hristo Smirnenski Blvd., 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/art.37715","article-title":"2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides","volume":"65","author":"Jennette","year":"2013","journal-title":"Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.autrev.2014.08.017","article-title":"Granulomatosis with polyangiitis (Wegener): Clinical aspects and treatment","volume":"13","author":"Comarmond","year":"2014","journal-title":"Autoimmun. 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