A patient presents with respiratory symptoms i.e.cough, hemoptysis and glomerulonephritis. His CANCAlevies in serum were found to be raised. Themost lkely diagnosis is :
**Core Concept**
The underlying principle being tested involves the correlation of clinical symptoms with specific autoantibody profiles, particularly in the context of vasculitides. **Wegener's granulomatosis**, now more commonly referred to as **Granulomatosis with Polyangiitis (GPA)**, is a form of vasculitis that affects small- and medium-sized vessels and is associated with the presence of **c-ANCA (cytoplasmic antineutrophil cytoplasmic antibodies)**.
**Why the Correct Answer is Right**
The patient's presentation of respiratory symptoms (cough, hemoptysis) along with glomerulonephritis and elevated **c-ANCA** levels is highly suggestive of **Granulomatosis with Polyangiitis (GPA)**. This condition is characterized by inflammation of the blood vessels (**vasculitis**) and the formation of granulomas, particularly in the respiratory tract, and can lead to renal involvement (**glomerulonephritis**). The presence of **c-ANCA**, which targets **proteinase 3 (PR3)**, is a diagnostic hallmark of GPA.
**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect because, although it might be a form of vasculitis, it doesn't specifically match the combination of symptoms and **c-ANCA** positivity described.
**Option B:** Incorrect as it doesn't align with the specific autoantibody profile and clinical presentation provided.
**Option C:** Incorrect because, while it could involve renal symptoms, it doesn't fit the full spectrum of symptoms and **c-ANCA** elevation.
**Option D:** Incorrect as it is not the condition most closely associated with **c-ANCA** and the described clinical presentation.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that **c-ANCA** positivity, particularly when associated with **PR3** antibodies, is strongly indicative of **GPA**, and patients often present with a combination of respiratory and renal symptoms.
**Correct Answer:** D. Granulomatosis with polyangiitis.