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ANCA-associated vasculitis — RACP Adult Medicine MCQ

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HardRheumatologyANCA-associated vasculitisRACP Adult Medicine

A 58-year-old man has chronic sinusitis, cough with haemoptysis and palpable purpura. Creatinine has risen to 210 micromol/L and urine microscopy shows dysmorphic red cells. Chest CT shows multiple cavitating nodules. What is the most likely diagnosis?

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Correct answer: E — Granulomatosis with polyangiitis

Upper airway disease, cavitating lung nodules, purpura and rapidly progressive glomerulonephritis suggest granulomatosis with polyangiitis. Anti-GBM disease causes pulmonary-renal syndrome but not chronic sinusitis with cavitating nodules. Sarcoidosis, PAN and skin-limited IgA vasculitis do not fit the combined ENT-lung-renal picture.

Reference: Therapeutic Guidelines (eTG) Rheumatology; AMH