<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2312-3893</journal-id>
<journal-title><![CDATA[Revista Virtual de la Sociedad Paraguaya de Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. virtual Soc. Parag. Med. Int.]]></abbrev-journal-title>
<issn>2312-3893</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2312-38932025000100409</article-id>
<article-id pub-id-type="doi">10.18004/rvspmi/2312-3893/2025.e12142509</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Granulomatosis con poliangeitis: presentación atípica de una enfermedad vasculítica compleja]]></article-title>
<article-title xml:lang="en"><![CDATA[Granulomatosis with polyangiitis: an atypical presentation of a complex vasculitic disease]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hernández Navas]]></surname>
<given-names><![CDATA[Jorge Andrés]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Therán León]]></surname>
<given-names><![CDATA[Juan Sebastián]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Dulcey Sarmiento]]></surname>
<given-names><![CDATA[Luis Andrés]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gómez Ayala]]></surname>
<given-names><![CDATA[Jaime Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[Wiston Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ochoa Castellanos]]></surname>
<given-names><![CDATA[Valentina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Santander Facultad de medicina ]]></institution>
<addr-line><![CDATA[Bucaramanga ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Mérida Facultad de medicina ]]></institution>
<addr-line><![CDATA[Mérida ]]></addr-line>
<country>Venezuela</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad Industrial de Santander Facultad de medicina ]]></institution>
<addr-line><![CDATA[Bucaramanga ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad Autónoma de Bucaramanga Facultad de medicina. ]]></institution>
<addr-line><![CDATA[Bucaramanga ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<volume>12</volume>
<numero>1</numero>
<fpage>409</fpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2312-38932025000100409&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2312-38932025000100409&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2312-38932025000100409&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN La granulomatosis con poliangeitis (GPA) es una vasculitis sistémica que afecta principalmente los vasos pequeños y medianos, con manifestaciones clínicas que incluyen la afectación pulmonar. Los pulmones son uno de los órganos más comprometidos y las lesiones típicas incluyen nódulos cavitarios, infiltrados y hemorragia alveolar. El diagnóstico temprano y el manejo adecuado son esenciales para evitar complicaciones graves. Se presenta caso de paciente femenina de 51 años, con antecedentes de artritis reumatoide, fibromialgia, síndrome de Sjögren, hipertensión arterial y tuberculosis latente. Presentó cefalea, poliuria, astenia y síntomas neuropsiquiátricos. Se identificó un adenoma hipofisiario mediante resonancia magnética y una lesión pulmonar cavitada, posiblemente por sobreinfección fúngica o secuela de tuberculosis. El perfil hormonal mostró hipotiroidismo e insuficiencia suprarrenal. El resultado de los anticuerpos citoplasmáticos antineutrófilos (ANCA-c) fue de 1:320. Recibió tratamiento con hidrocortisona, levotiroxina, desmopresina y ciclofosfamida. La paciente mostró mejoría significativa, y se planificó seguimiento ambulatorio con endocrinología y reumatología para ajustes terapéuticos y control de comorbilidades.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Granulomatosis with polyangiitis (GPA) is a systemic vasculitis that mainly affects small and medium-sized vessels, with clinical manifestations including pulmonary involvement. The lungs are one of the most involved organs, and typical lesions include cavitary nodules, infiltrates, and alveolar hemorrhage. Early diagnosis and proper management are essential to avoid serious complications. We present the case of a 51-year-old female patient with a history of rheumatoid arthritis, fibromyalgia, Sjögren's syndrome, arterial hypertension, and latent tuberculosis. She presented with headache, polyuria, asthenia, and neuropsychiatric symptoms. A pituitary adenoma was identified by MRI and a cavitated lung lesion, possibly due to fungal superinfection or sequelae of tuberculosis. Hormonal profile showed hypothyroidism and adrenal insufficiency. The antineutrophil cytoplasmic antibodies (c-ANCA) result was 1:320. She received treatment with hydrocortisone, levothyroxine, desmopressin, and cyclophosphamide. The patient showed significant improvement, and outpatient follow-up with endocrinology and rheumatology was planned for therapeutic adjustments and control of comorbidities.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[vasculitis]]></kwd>
<kwd lng="es"><![CDATA[vasculitis asociada a anticuerpos citoplasmáticos antineutrófilos]]></kwd>
<kwd lng="es"><![CDATA[granulomatosis con poliangitis]]></kwd>
<kwd lng="en"><![CDATA[vasculitis]]></kwd>
<kwd lng="en"><![CDATA[antineutrophil cytoplasmic antibody-associated vasculitis]]></kwd>
<kwd lng="en"><![CDATA[granulomatosis with polyangiitis]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[White]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Dubey]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Eosinophilic granulomatosis with polyangiitis]]></article-title>
<source><![CDATA[Autoimmun Rev]]></source>
<year>2023</year>
<volume>22</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>103219</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peraza Labrador]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Valdez]]></surname>
<given-names><![CDATA[LHM]]></given-names>
</name>
<name>
<surname><![CDATA[Gonzalez Marin]]></surname>
<given-names><![CDATA[NR]]></given-names>
</name>
<name>
<surname><![CDATA[Ibazetta]]></surname>
<given-names><![CDATA[KAR]]></given-names>
</name>
<name>
<surname><![CDATA[Chacón]]></surname>
<given-names><![CDATA[JAL]]></given-names>
</name>
<name>
<surname><![CDATA[Fernandez]]></surname>
<given-names><![CDATA[AJV]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Oral granulomatosis with polyangiitis a systematic review]]></article-title>
<source><![CDATA[Clin Exp Dent Res]]></source>
<year>2023</year>
<volume>9</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>100-11</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bettiol]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Urban]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[Dagna]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Cottin]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Franceschini]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Del Giacco]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Mepolizumab for eosinophilic granulomatosis with polyangiitis]]></article-title>
<source><![CDATA[Arthritis Rheumatol]]></source>
<year>2022</year>
<volume>74</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>295-306</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wechsler]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Hellmich]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Cid]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Jayne]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Tian]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Baylis]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Roufosse]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Unmet needs and evidence gaps in hypereosinophilic syndrome and eosinophilic granulomatosis with polyangiitis]]></article-title>
<source><![CDATA[J Allergy Clin Immunol]]></source>
<year>2023</year>
<volume>151</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1415-28</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Higashihara]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Kawamura]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Miyazaki]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Yokoo]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Joh]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Granulomatosis with polyangiitis presenting as a solitary renal mass]]></article-title>
<source><![CDATA[BMC Nephrol]]></source>
<year>2023</year>
<volume>24</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>223</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lyons]]></surname>
<given-names><![CDATA[PA]]></given-names>
</name>
<name>
<surname><![CDATA[Peters]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Alberici]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Liley]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Coulson]]></surname>
<given-names><![CDATA[RMR]]></given-names>
</name>
<name>
<surname><![CDATA[Astle]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Genome-wide association study of eosinophilic granulomatosis with polyangiitis reveals genomic loci stratified by ANCA status]]></article-title>
<source><![CDATA[Nat Commun]]></source>
<year>2019</year>
<volume>10</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>5120</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Moin]]></surname>
<given-names><![CDATA[KA]]></given-names>
</name>
<name>
<surname><![CDATA[Yeakle]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Parrill]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Garofalo]]></surname>
<given-names><![CDATA[VA]]></given-names>
</name>
<name>
<surname><![CDATA[Tsiyer]]></surname>
<given-names><![CDATA[AR]]></given-names>
</name>
<name>
<surname><![CDATA[Bishev]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Ocular and orbital manifestations of granulomatosis with polyangiitis]]></article-title>
<source><![CDATA[Rom J Ophthalmol]]></source>
<year>2023</year>
<volume>67</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>214-21</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cleary]]></surname>
<given-names><![CDATA[JO]]></given-names>
</name>
<name>
<surname><![CDATA[Sivarasan]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Ch]]></surname>
<given-names><![CDATA[Burd]]></given-names>
</name>
<name>
<surname><![CDATA[Connor]]></surname>
<given-names><![CDATA[SEJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Head and neck manifestations of granulomatosis with polyangiitis]]></article-title>
<source><![CDATA[Br J Radiol]]></source>
<year>2021</year>
<volume>94</volume>
<numero>1119</numero>
<issue>1119</issue>
<page-range>20200914</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Tang]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Gut microbiota and immune mediation]]></article-title>
<source><![CDATA[Front Immunol]]></source>
<year>2023</year>
<volume>14</volume>
<page-range>1296016</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sanchez-Alamo]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Schirmer]]></surname>
<given-names><![CDATA[JH]]></given-names>
</name>
<name>
<surname><![CDATA[Hellmich]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Jayne]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Monti]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Tomasson]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Luqmani]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Systematic literature review informing the 2022 update of the EULAR recommendations for the management of ANCA-associated vasculitis (AAV)]]></article-title>
<source><![CDATA[RMD Open]]></source>
<year>2023</year>
<volume>9</volume>
<numero>2</numero>
<issue>2</issue>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
