Wegener's granulomatosis is characterized by granulomatous vasculitis of the upper and lower respiratory tracts together with glomerulonephritis. Male-to-female ratio is 1:1. And the mean age of onset is 40 years. Clinical features: Patients often present with paranasal sinus pain, purulent or bloody nasal discharge, with or without nasal mucosal ulceration, nasal septal perforation and serous otitis media. Pulmonary involvement results in as cough, hemoptysis, dyspnea, and chest discomfo. Due to renal disease patients develop proteinuria, hematuria, and red blood cell casts. Ref: Harrison's Internal Medicine, 18th Edition, Pages 2789, Chapter 326