iatroX Rounds #22
The clues
- 1
A 54 year old man presents with a persistent runny nose, crusting, and intermittent nosebleeds that have lasted for four months.
- 2
He has now developed a new cough and has noticed blood in his phlegm, alongside a feeling of general malaise and night sweats.
- 3
Over the last few weeks he has also experienced a decrease in his hearing and persistent pain in his left ear.
- 4
On examination, there is a visible saddle nose deformity and urinalysis reveals the presence of both blood and protein.
- 5
His blood results show a rapidly rising creatinine and a chest radiograph reveals multiple cavitating pulmonary nodules.
- 6
Testing for antineutrophil cytoplasmic antibodies shows a cytoplasmic staining pattern with specific positivity for proteinase 3 antibodies.
Granulomatosis with polyangiitis is a small vessel vasculitis that typically involves the upper respiratory tract, lungs, and kidneys. It is characterized by necrotising granulomatous inflammation and is strongly associated with specific autoantibodies.
- Saddle nose deformity and chronic refractory sinusitis
- Pulmonary nodules with cavitation and haemoptysis
- Rapidly progressive glomerulonephritis with haematuria
for education and entertainment. not medical advice.