European Journal of Case Reports in Internal Medicine


The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM). The journal wants to promote the practice of internal medicine in Europe. Its aim is to provide a forum to internal medicine doctors.
EJCRIM welcomes papers describing unusual or complex cases and case series that an internist may encounter in everyday practice. Case series are also welcomed as long as they demonstrate the appropiateness of a therapeutical approach or unusual manifestation of a disease.
The journal would also consider brief reasoned reports of issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to scientific meetings of European societies of Internal Medicine.

EJCRIM utilizes the CNR-SOLAR system to permanently archive the journal for purposes of preservation, reservation and research and it is also indexed on Google Scholar and DOAJ. We encourage the use of Kudos to maximize the article's visibility. 

EJCRIM is peer-reviewed with single-blind review and freely accessible to all.

Antreas Iacovou Ioannou, Dimitra Dimitriou, Panagiotis Dimitriou, Aram Katsios, Georgios Petrikkos
Kapil Kumar Garg, Harpreet Singh
Kenta Hamada, Yoji Takeuchi, Tomofumi Akasaka, Hiroyasu Iishi
António Araújo Ferreira, Alexandra Esteves, Yolanda Mahia, Aristóteles Rosmaninho, Augusta Silva
Ricardo Fonseca, Filipa Monteiro, Rita Mendes
António Miguel Araújo Ferreira, Susana Manuela Barbosa, Soraia Oliveira, José Ramada, Augusta Silva

ANCA-negative Granulomatosis with Polyangiitis: A Difficult Diagnosis

Eilís McCarthy, Muneeb Mustafa, Mike Watts
Published: 18/07/2017


Granulomatosis with polyangitiis (GPA) is a systemic small and medium vessel vasculitis, commonly associated with anti-neutrophil cytoplasmic antibodies (ANCAs). Presenting signs and symptoms in GPA are varied and patients may present with constitutional, non-specific symptoms, which can delay the diagnosis. Tissue biopsy of the site of active disease can confirm the diagnosis of GPA, in which necrotising granulomatous inflammation is seen. However, surrogate markers may be used for diagnosis without a tissue biopsy. They include upper and lower airway symptoms, signs of glomerulonephritis and a positive ANCA. However, approximately 10–20% of patients with GPA are ANCA negative, allowing for the diagnosis to be overlooked, particularly in those patients with non-specific findings. The reason for the absence of ANCAs is unclear.