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Granulomatosis with polyangiitis — SCE Rheumatology MCQ

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ModerateVasculitisGranulomatosis with polyangiitisSCE Rheumatology

A 58-year-old man presents with haemoptysis, sinus crusting and rapidly rising creatinine. Urine microscopy shows red cell casts, CT chest shows cavitating nodules and PR3-ANCA is strongly positive. Oxygen saturations are 93% on air. What is the most likely diagnosis?

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Correct answer: E — Granulomatosis with polyangiitis

ENT disease, cavitating lung nodules, glomerulonephritis and PR3-ANCA strongly support granulomatosis with polyangiitis. Anti-GBM disease can cause pulmonary-renal syndrome but does not usually cause chronic destructive ENT disease or cavitating nodules. MPA more often lacks granulomatous ENT disease.

Reference: BSR ANCA-associated vasculitis recommendations 2025; EULAR AAV recommendations