A 28-year-old woman presents to the emergency department with a recent episode of coughing up some blood, frequent nosebleeds, and now decreased urine output. On physical examination, a nasal mucosa ulcer is seen on inspection and the remainder of the examination is normal. Her urinalysis is positive for protein and red cells consistent with acute glomerulonephritis (GN). The CXR shows two cavitary lesions and her serology is positive for antineutrophil cytoplasmic antibodies (ANCA) Which of the following is the most likely diagnosis?
Correct Answer: Wegener granulomatosis
Description: Wegener is typically associated with anti-neutrophil cytoplasmic antibodies and respiratory epithelium involvement such as frequent nose bleeds or nasal ulcers. Numerous diseases are associated with renal and pulmonary manifestations, including lupus, Goodpasture syndrome, and microscopic polyangiitis. Right-sided bacterial endocarditis can cause renal and lung involvement but serology of ANCA is negative in endocarditis. This is less likely to be Goodpasture because of the nasal involvement.
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