A 55 year-old man presents to his physician complaining of sinusitis, chest pain and productive cough for 2 weeks. His sputum is mixed with blood. He also has pain and swelling of hands and feet for 3 months. On examination, he has synovitis of proximal interphalangeal joints of both hands. His laboratory tests reveal anemia, elevated ESR, elevated creatinine and positive c-ANCA. Urinalysis shows red blood casts and proteinuria. Chest x-ray shows multiple nodules in both lungs.
What is the most likely diagnosis?
A- Acute glomerulonephritis
B- Miliary tuberculosis
C- Wegener granulomatosis
D- Rheumatoid arthritis
E- Systemic lupus erythematosus
This is a typical case of Wegener granulomatosis which is characterized by upper and lower respiratory and renal involvement. Positive c-ANCA confirms the diagnosis.