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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#58;</p><p class="elsevierStylePara">Wegener&#191;s granulomatosis &#40;WG&#41; is a systemic vasculitis affecting vessels of small and medium diameter&#44; the upper and lower respiratory tract&#44; as well as the kidneys&#46;<span class="elsevierStyleSup">1</span> Although rare&#44; systemic vasculitis can present itself as lesions resembling tumours&#44; which can initially delay diagnosis and treatment&#46;<span class="elsevierStyleSup">2&#44;3</span> We present the first such case of WG described in the literature&#44; which presented with multiple masses in different locations&#46;</p><p class="elsevierStylePara">37 year old woman who presented with weight loss&#44; febricula&#44; fatigue and night sweats&#46; Symptoms had been present for six months&#46; A physical examination revealed a palpable right supraclavicular mass and a mass on the abdominal wall at hypogastric level&#46; The rest of the examination was normal&#46; The laboratory showed a haematocrit of 23&#37;&#44; erythrocyte sedimentation rate &#40;ESR&#41; of 120mm in one hour &#40;normal &#60;20&#41;&#44; with no microhaematuria or renal insufficiency&#46; The chest x-ray showed a left apical mass which in the CT measured 6cm by 5cm with central necrosis&#44; without cavitation&#44; or hilar or mediastinal adenopathy&#46; The antineutrophil cytoplasmic antibodies &#40;ANCAs&#41; were positive in high titres &#40;810 AU&#44; normal &#60;10&#41; and the enzyme immunoassay &#40;ELISA&#41; revealed specificity for the proteinase 3 antigen&#46; A surgical biopsy of the right supraclavicular mass showed a necrotising granulomatous inflammation&#46; Afibrobronchoscopy with bronchoalveolar lavage was performed&#44; which showed up negative for neoplastic cells and infection&#59; the transbronchial biopsy showed necrotising vasculitis&#46; PPD and cultures were negative&#46; Based on the above&#44; the patient was diagnosed with WG&#46; Treatment with cyclophosphamide 150mg&#47;day and prednisone 60mg&#47;day improved all manifestations&#46; Disappearance of the pulmonary and hypogastric masses was&#160;observed&#46; The patient remained asymptomatic after one year&#46;</p><p class="elsevierStylePara">In the literature&#44; 89 cases of vasculitis presenting as a mass have been described&#46; <span class="elsevierStyleSup">2&#44;3</span> In all of these cases the mass was present in only one location or organ&#44; unlike our patient&#46; The average age in the cases described was 50&#46;5 &#43; 15&#46;8 years&#44; and 51&#37; were female&#46; In 82&#37; of cases&#44; the &#191;tumour&#191; was associated with constitutional symptoms and an elevated ESR&#46; In approximately half of the patients&#44; surgery was performed prior to diagnosis&#46; The most frequent location for the masses was the breast &#40;22&#37;&#41;&#44; followed by lesions in the central nervous system &#40;16&#37;&#41;&#46; Another common location is the ovary &#40;10&#37;&#41;&#44; caused by giant cell arteritis &#40;GCA&#41;&#44; and in the male&#44; in the genitourinary system&#44; caused by polyarteritis nodosa &#40;PAN&#41;&#46; </p><p class="elsevierStylePara">WG is the most common cause of vasculitic masses &#40;32 cases&#41;&#44; followed by GCA &#40;18 cases&#41; and PAN &#40;17 cases&#41;&#44; among others&#46; WG is distinguished by the diversity of the locations in which the lesions &#40;masses&#41; are found&#44; comprising twelve different positions &#40;the most common being the breast and kidney&#41;&#46; In patients with GCA&#44; the masses are located only on the breast and ovary&#46;</p><p class="elsevierStylePara">The purpose of this article is to draw attention to this unusual presentation of vasculitis&#46; The improvement on old imaging methods&#44; such as highresolution tomography or nuclear magnetic resonance&#44; among others&#44; and the arrival of ANCAs&#44; can assist with preoperative diagnosis&#46; The inclusion of vasculitis in the differential diagnosis of lesions or masses leads to an earlier correct diagnosis and&#44; consequently&#44; the establishment of an appropriate treatment&#44; avoiding unnecessary surgery&#46;</p>"
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Multiple masses as a presentation of Wegener's disease
Masas múltiples como presentación de enfermedad de Wegener
Pablo Younga, Bárbara C Finna, Maria E Ceballosa, Martin Iturraspea, Mariano Forrestera
a Hospital Británico de Bueno Aires Bueno Aires Argentina, Argentina,
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