A65-year-old male adult presents with chronic sinusitis, nasopharyngeal ulcers, cavitatory lung nodules and renal failure. What will be the appropriate next diagnostic step?
(A) Lung biopsy (B) Sputum AFB and PCR for TB (C) ANCA and evaluation for vasculitis (D) ESR
(C) Ans: C. ANCA and evaluation for vasculitis(Ref Harrison 19/e p2182-2184, 18/e p2786, 2789)Suggestive of Wegener's Granulomatosis.Wegener's Granulomatosis:c-ANCA positive small vessel vasculitis. levels are required for diagnosis.Tests:Specificity of a positive antiproteinase-3 ANCA for granulomatosis with polyangiitis (Wegener's) is very high, especially if active glomerulonephritis is present.However, the presence of ANCA should be adjunctive and, with rare exceptons, should not substitute for a tissue diagnosis.