A 45 year old man presents with hematuria. Renal biopsy demonstrates a focal necrotizing glomerulonephritis with crescent formation. The patient gives history of intermittent hemoptysis and intermittent chest pain of moderate intensity. A previous chest X-ray had demonstrated 90 multiple opacities, some of which were cavitated. The patient also has chronic cold like nasal symptoms. What is the most probable diagnosis?
The patient has involvement of: Upper respiratory tract= chronic cold symptoms suggestive of sinusitis Lower respiratory tract = intermittent hemoptysis due to bilateral lung cavitation Kidney involvement= Hematuria with necrotizing vasculitis. Diagnosis goes in or of granulomatosis with angitis (Wegener's Granulomatosis). For diagnosis c-ANCA will be helpful along with biopsy findings of vasculitis. The cytoplasmic pattern of immunofluorescence (c-ANCA) is caused by PR3-ANCA and has high specificity>90% for granulomatosis with angitis. Aspergillosis Involve lungs in invasive aspergilloma but multiple cavity formation is not seen and neither is glomerulonephritis. Polyaeritis nodosa Ruled out as lung and pulmonary aery involvement is not seen. Renal cell carcinoma metastatic to lung Ruled out since it is mentioned that Renal biopsy shows segmental necrotizing glomerulonephritis
Aspergillosis
Polyaeritis nodosa
Renal carcinoma metastatic to lung
Wegener's granulomatosis
Vasculitis