A 25 years old female develops serous otitis media of left ear with cough, occasional hemoptysis, hematuria and epistaxis for one & half months. Her hemoglobin is 7 gm, BP- 170/100, proteinuria +++, RA -ve and ANCA -ve. The likely cause is –
**Core Concept**
The patient presents with a combination of symptoms including serous otitis media, cough, hemoptysis, hematuria, epistaxis, and systemic hypertension, alongside laboratory findings of severe anemia and significant proteinuria. This clinical picture is suggestive of a systemic vasculitis affecting multiple organ systems.
**Why the Correct Answer is Right**
The patient's symptoms and laboratory findings are consistent with a diagnosis of Wegener's granulomatosis (now referred to as Granulomatosis with Polyangiitis, GPA), a form of small-vessel vasculitis. GPA is characterized by the presence of granulomas in the respiratory tract and vasculitis affecting small to medium-sized vessels. The patient's symptoms of cough, hemoptysis, and serous otitis media suggest involvement of the respiratory tract, while hematuria and proteinuria indicate renal involvement. The presence of epistaxis and systemic hypertension further support this diagnosis. The absence of anti-neutrophil cytoplasmic antibodies (ANCA) does not rule out GPA, as not all patients with GPA test positive for ANCA.
**Why Each Wrong Option is Incorrect**
**Option A:** While Goodpasture syndrome presents with renal and pulmonary manifestations, it is typically associated with the presence of anti-GBM antibodies, which are not mentioned in this case.
**Option B:** Systemic lupus erythematosus (SLE) can present with a wide range of systemic symptoms, but the combination of serous otitis media, cough, hemoptysis, and significant proteinuria is not typical of SLE.
**Option C:** Polyarteritis nodosa (PAN) is a form of medium-vessel vasculitis that can present with systemic symptoms, but it is less likely to involve the respiratory tract and kidneys in this manner.
**Clinical Pearl / High-Yield Fact**
In patients presenting with a combination of respiratory and renal symptoms, consider the diagnosis of Granulomatosis with Polyangiitis (GPA), even in the absence of ANCA positivity. Remember that GPA can present with a wide range of symptoms and can involve multiple organ systems.
**Correct Answer:** D