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Granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis, is a vasculitis that primarily affects the respiratory tract and kidneys(1). Known as a rare disease, predominantly affects Caucasian adults aged between 45 and 60 years(2). While the specific cause remains unclear, it is believed that environmental factors play a role in triggering the condition in individuals who are genetically predisposed(3). There is a wide range of clinical manifestations, comprising both general nonspecific symptoms(4) and organ-specific symptoms, with lung involvement in nearly 90% of patients(5). The diagnosis relies on clinical and imaging criteria, along with histopathological confirmation(2). Treatment consists of an induction phase, followed by a maintenance phase, utilizing glucocorticoids and immunosuppressants, which has greatly enhanced the prognosis for these patients(6). The objective of this paper is to illustrate the complexity of GPA through the presentation of a clinical case. The patient is a 59-year-old man with a professional background involving exposure to respiratory toxins who presented to the clinic with intermittent mucopurulent cough, episodes of hemoptysis, nonspecific chest pain, bilateral knee pain, weight loss, and excessive nocturnal sweating. The imaging findings indicated significant polymorphic lesions in the lungs, and the diagnosis of GPA was confirmed via transthoracic biopsy. Using a therapeutic strategy of immunosuppression and oral corticosteroid therapy, the patient's clinical condition showed a modest improvement. The particularity of this case lies in the need to revise the treatment strategy for a patient identified as a non-responder to cyclophosphamide, given the imaging, functional and biological decline observed under the initial immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

What is the “fantasmatic deixis”? It is a very creative and productive cognitive–linguistic operation that allows a “transfer” to other real or fantastic times, places, and “worlds”. The underlying psychological question concerns the possibility of moving and being moved with respect to something or someone who is absent (Bühler, 1965). This “fiction game” is made possible by deictic indicators (Tenchini, 2008), terms that allow motion in time and space, always considering the here–now–I system of subjective orientation. When we refer to something that can be gathered by hearing or by sight, by terms such as here, there, I, and you, the receiver can easily use natural, prelinguistic aids (e.g., gestures, voice quality, facial expressions, and body orientation) to understand what the issuer intends to communicate to him (demonstratio ad oculos). But what happens when we move from the study of “immediate” behavior to that of “mediate” behavior, i.e., the field of memories (retrospection) or the constructive fantasy (prospecting)? The fantasmatic deixis implies enfranchisement from the physical position of the body and requires the assumption of the listener’s current tactile body image. Thus, the receiver assumes an inner attitude to correctly interpret the indications given by the speaker, seeing and hearing through the “inner” or “mental” eye and ear (Raynaud, 2006). In this way, the listener can bring something absent in his/her here, now, and I or feel moved to the point where the speaker leads him/her. My paper will focus on the features and types of fantasmatic deixis, providing some examples and showing how this operation involves language, motion, and cognitive processes.