title: Wegener's granulomatosis presenting as meningitis.
abstract: BACKGROUND
  Wegener's granulomatosis is a rare but well recognised autoimmune necrotising vasculitis. Presentation of disease in the head and neck is common and mostly consists of nasal crusting, blockage and bloody discharge. Neurological presentation is very uncommon.
  
  
  METHODS
  We report a patient who presented to the medical emergency services with signs and symptoms of meningitis, but who was eventually diagnosed with Wegener's granulomatosis. A literature search on this topic was carried out using Medline and Embase (1996 to 2011), searching for 'Wegener's granulomatosis' and 'meningitis'.
  
  
  RESULTS
  After thorough neurological and medical investigation, a combination of brain computed tomography, lumbar puncture, nasal biopsy and laboratory results refuted the diagnosis of meningitis and confirmed the diagnosis of Wegener's granulomatosis.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first English-language case report of a patient with Wegener's granulomatosis presenting with symptoms of meningitis unconfirmed on computed tomography and lumbar puncture.
authors.affiliation: Department of Otorhinolaryngology, Aberdeen Royal Infirmary, Scotland, UK. gundulathiel@doctors.org.uk
authors.forename: G
authors.initials: G
authors.lastname: Thiel
authors.forename: M
authors.initials: M
authors.lastname: Shakeel
authors.forename: K
authors.initials: K
authors.lastname: Ah-See
mesh_terms: D000208:Acute Disease; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis; D001706:Biopsy; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D006261:Headache / Q000175:diagnosis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008581:Meningitis / Q000175:diagnosis*; D008875:Middle Aged; D009668:Nose Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D013129:Spinal Puncture; D014057:Tomography, X-Ray Computed
chemical_list: D000893:Anti-Inflammatory Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone