array:21 [
  "pii" => "X2013251409003327"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.2009.29.4.5005.en.full"
  "estado" => "S300"
  "fechaPublicacion" => "2009-08-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2009;29:376-7"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2899
    "formatos" => array:3 [
      "EPUB" => 237
      "HTML" => 2249
      "PDF" => 413
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X021169950900332X"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.2009.29.4.5005.en.full"
      "estado" => "S300"
      "fechaPublicacion" => "2009-08-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2009;29:376-7"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 5355
        "formatos" => array:3 [
          "EPUB" => 225
          "HTML" => 4701
          "PDF" => 429
        ]
      ]
      "es" => array:9 [
        "idiomaDefecto" => true
        "titulo" => "Masas múltiples como presentación de enfermedad de Wegener"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "376"
            "paginaFinal" => "377"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Multiple masses as a presentation of Wegener¿s disease"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Pablo Young, Bárbara C Finn, Maria E Ceballos, Martin Iturraspe, Mariano Forrester"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "Pablo"
                "apellidos" => "Young"
              ]
              1 => array:2 [
                "nombre" => "Bárbara"
                "apellidos" => "C Finn"
              ]
              2 => array:2 [
                "nombre" => "Maria"
                "apellidos" => "E Ceballos"
              ]
              3 => array:2 [
                "nombre" => "Martin"
                "apellidos" => "Iturraspe"
              ]
              4 => array:2 [
                "nombre" => "Mariano"
                "apellidos" => "Forrester"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251409003327"
          "doi" => "10.3265/Nefrologia.2009.29.4.5005.en.full"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003327?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X021169950900332X?idApp=UINPBA000064"
      "url" => "/02116995/0000002900000004/v0_201502091407/X021169950900332X/v0_201502091407/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251409003319"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.4.5150.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-08-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2009;29:377-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3407
      "formatos" => array:3 [
        "EPUB" => 254
        "HTML" => 2703
        "PDF" => 450
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Long term hypopotassaemia associated with chlorthalidone"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "377"
          "paginaFinal" => "378"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "HIPOPOTASEMIA DE LARGA DURACIÓN ASOCIADA A CLORTALIDONA"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Francisco José Nicolás Sánchez, Rosa María Sarrat Nuevo, Teodoro Soler Rosell, Ana María Gort Oromí"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Francisco José"
              "apellidos" => "Nicolás Sánchez"
            ]
            1 => array:2 [
              "nombre" => "Rosa María"
              "apellidos" => "Sarrat Nuevo"
            ]
            2 => array:2 [
              "nombre" => "Teodoro"
              "apellidos" => "Soler Rosell"
            ]
            3 => array:2 [
              "nombre" => "Ana María"
              "apellidos" => "Gort Oromí"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509003311"
        "doi" => "10.3265/Nefrologia.2009.29.4.5150.en.full"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003311?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003319?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000004/v0_201502091627/X2013251409003319/v0_201502091628/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251409003335"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.4.5159.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-08-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2009;29:375-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3175
      "formatos" => array:3 [
        "EPUB" => 261
        "HTML" => 2470
        "PDF" => 444
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Disease caused by anti-glomerular basement membrane antibodies and haematoma of the recti"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "375"
          "paginaFinal" => "376"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad por anticuerpos antimembrana basal y hematoma de los rectos"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "14318078_f1_375.jpg"
              "Alto" => 248
              "Ancho" => 258
              "Tamanyo" => 14205
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Perez de José, Carmen Bernis, Yolanda Hernandez, Karina Furaz, Jose Antonio Sanchez Tomero"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Perez de José"
            ]
            1 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "Bernis"
            ]
            2 => array:2 [
              "nombre" => "Yolanda"
              "apellidos" => "Hernandez"
            ]
            3 => array:2 [
              "nombre" => "Karina"
              "apellidos" => "Furaz"
            ]
            4 => array:2 [
              "nombre" => "Jose Antonio"
              "apellidos" => "Sanchez Tomero"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509003338"
        "doi" => "10.3265/Nefrologia.2009.29.4.5159.en.full"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003338?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003335?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000004/v0_201502091627/X2013251409003335/v0_201502091628/en/main.assets"
  ]
  "en" => array:10 [
    "idiomaDefecto" => true
    "titulo" => "Multiple masses as a presentation of Wegener's disease"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "376"
        "paginaFinal" => "377"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Pablo Young, Bárbara C Finn, Maria E Ceballos, Martin Iturraspe, Mariano Forrester"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Pablo"
            "apellidos" => "Young"
            "email" => array:1 [
              0 => "pabloyoung2003@yahoo.com.ar"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "B&#225;rbara"
            "apellidos" => "C Finn"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Maria"
            "apellidos" => "E Ceballos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Martin"
            "apellidos" => "Iturraspe"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Mariano"
            "apellidos" => "Forrester"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => " Hospital Británico de Bueno Aires Bueno Aires Argentina, Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Masas m&#250;ltiples como presentaci&#243;n de enfermedad de Wegener"
      ]
    ]
    "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>"
    "pdfFichero" => "P-E-S-A144-EN.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:3 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shafiei K, Luther E, Archie M, Gulick J, Fowler MR. Wegener granulomatosis: case report and brief literature review. J Am Board Fam Pract 2003;16:555-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14963084" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Revital K, Yechezkel S, Hanan G. Systemic vasculitis presenting as a tumorlike lesion. Four case reports and an analysis of 79 reported cases. Medicine (Baltimore) 2000;79:349-59."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Roussou M, Dimopoulos SK, Dimopoulos MA, Anastasiou-Nana MI. Wegener¿s granulomatosis presenting as a renal mass. Urology 2008;71:547.e1-2."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002900000004/v0_201502091627/X2013251409003327/v0_201502091628/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35436"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000004/v0_201502091627/X2013251409003327/v0_201502091628/en/P-E-S-A144-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003327?idApp=UINPBA000064"
]
Share
Journal Information
Vol. 29. Issue. 4.August 2009
Pages 285-378
Vol. 29. Issue. 4.August 2009
Pages 285-378
Full text access
Multiple masses as a presentation of Wegener's disease
Masas múltiples como presentación de enfermedad de Wegener
Visits
6192
Pablo Younga, Bárbara C Finna, Maria E Ceballosa, Martin Iturraspea, Mariano Forrestera
a Hospital Británico de Bueno Aires Bueno Aires Argentina, Argentina,
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text

Dear Editor:

Wegener¿s granulomatosis (WG) is a systemic vasculitis affecting vessels of small and medium diameter, the upper and lower respiratory tract, as well as the kidneys.1 Although rare, systemic vasculitis can present itself as lesions resembling tumours, which can initially delay diagnosis and treatment.2,3 We present the first such case of WG described in the literature, which presented with multiple masses in different locations.

37 year old woman who presented with weight loss, febricula, fatigue and night sweats. Symptoms had been present for six months. A physical examination revealed a palpable right supraclavicular mass and a mass on the abdominal wall at hypogastric level. The rest of the examination was normal. The laboratory showed a haematocrit of 23%, erythrocyte sedimentation rate (ESR) of 120mm in one hour (normal <20), with no microhaematuria or renal insufficiency. The chest x-ray showed a left apical mass which in the CT measured 6cm by 5cm with central necrosis, without cavitation, or hilar or mediastinal adenopathy. The antineutrophil cytoplasmic antibodies (ANCAs) were positive in high titres (810 AU, normal <10) and the enzyme immunoassay (ELISA) revealed specificity for the proteinase 3 antigen. A surgical biopsy of the right supraclavicular mass showed a necrotising granulomatous inflammation. Afibrobronchoscopy with bronchoalveolar lavage was performed, which showed up negative for neoplastic cells and infection; the transbronchial biopsy showed necrotising vasculitis. PPD and cultures were negative. Based on the above, the patient was diagnosed with WG. Treatment with cyclophosphamide 150mg/day and prednisone 60mg/day improved all manifestations. Disappearance of the pulmonary and hypogastric masses was observed. The patient remained asymptomatic after one year.

In the literature, 89 cases of vasculitis presenting as a mass have been described. 2,3 In all of these cases the mass was present in only one location or organ, unlike our patient. The average age in the cases described was 50.5 + 15.8 years, and 51% were female. In 82% of cases, the ¿tumour¿ was associated with constitutional symptoms and an elevated ESR. In approximately half of the patients, surgery was performed prior to diagnosis. The most frequent location for the masses was the breast (22%), followed by lesions in the central nervous system (16%). Another common location is the ovary (10%), caused by giant cell arteritis (GCA), and in the male, in the genitourinary system, caused by polyarteritis nodosa (PAN).

WG is the most common cause of vasculitic masses (32 cases), followed by GCA (18 cases) and PAN (17 cases), among others. WG is distinguished by the diversity of the locations in which the lesions (masses) are found, comprising twelve different positions (the most common being the breast and kidney). In patients with GCA, the masses are located only on the breast and ovary.

The purpose of this article is to draw attention to this unusual presentation of vasculitis. The improvement on old imaging methods, such as highresolution tomography or nuclear magnetic resonance, among others, and the arrival of ANCAs, can assist with preoperative diagnosis. The inclusion of vasculitis in the differential diagnosis of lesions or masses leads to an earlier correct diagnosis and, consequently, the establishment of an appropriate treatment, avoiding unnecessary surgery.

Bibliography
[1]
Shafiei K, Luther E, Archie M, Gulick J, Fowler MR. Wegener granulomatosis: case report and brief literature review. J Am Board Fam Pract 2003;16:555-9. [Pubmed]
[2]
Revital K, Yechezkel S, Hanan G. Systemic vasculitis presenting as a tumorlike lesion. Four case reports and an analysis of 79 reported cases. Medicine (Baltimore) 2000;79:349-59.
[3]
Roussou M, Dimopoulos SK, Dimopoulos MA, Anastasiou-Nana MI. Wegener¿s granulomatosis presenting as a renal mass. Urology 2008;71:547.e1-2.
Download PDF
Idiomas
Nefrología (English Edition)
Article options
Tools