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GPA — RACP Adult Medicine MCQ

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ModerateRespiratoryGPARACP Adult Medicine

A 35-year-old man presents with a 3-week history of haemoptysis, nasal crusting, and sinusitis. Urinalysis shows haematuria and red cell casts. His creatinine is 280 µmol/L. CT chest shows bilateral pulmonary infiltrates. What is the most likely diagnosis?

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Correct answer: D — Granulomatosis with polyangiitis (GPA)

The triad of upper airway disease (nasal crusting, sinusitis), pulmonary involvement (haemoptysis, infiltrates), and glomerulonephritis (haematuria, red cell casts, raised creatinine) is classic for GPA (formerly Wegener's granulomatosis). PR3-ANCA (c-ANCA) is positive in ~90% of cases with generalised disease. Urgent treatment with cyclophosphamide or rituximab plus glucocorticoids is indicated.

Reference: eTG – 2025 – Rheumatology; ANZDATA – 2024 – Renal Guidelines