A 46-year-old man who suffers from chronic sinusitis presents with acute cough. In addition, he complained of mild joint pains and redness of eyes. On examination he is febrile without any signs of respiratory distress. His blood pressure was 140/90. His abdomen was soft and revealed no organomegaly. Chest X-ray revealead a single well-defined nodule. CT of his sinuses thickening of mucosa of all the sinuses. His investigations revealed haemoglobin 12 g/dL, elevated erythrocyte sedimentation rates and CRP.
His serum creatinine also was mildly elevated. Sputum examination was negative for mycobacterium and fungi. Biopsy of the lung nodule showed granulomatous inflammation. His rheumatoid factor was 566 IU/ml and antinuclear antibodies were negative. Anti-proteinase 3 antibodies were positive. What is the probable diagnosis? Which other organ system must be closely scrutinised?…
