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A correction has been published: N Engl J Med 1998;339(21):1564.

Case Records of the Massachusetts General Hospital
Weekly Clinicopathological Exercises
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Volume 339:755-763 September 10, 1998 Number 11
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Case 28-1998— A 64-Year-Old Man with Cranial-Nerve Palsies and a Positive Test for Antinuclear Cytoplasmic Antibodies
Robert W. Simms, and Robin E. Kirby

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Presentation of Case

A 64-year-old man was admitted to the hospital because of a productive cough during treatment for suspected Wegener's granulomatosis.

The patient had been well until seven months earlier, when he began to have unsteadiness and right-sided tinnitus, with constant maxillary, nasal, frontal, and temporal pain, which was more prominent on the right side. Treatment with prednisone (40 mg daily) was begun, with considerable improvement of the headache. A biopsy of the left temporal artery showed no evidence of arteritis. Two months before admission, a test for antineutrophil cytoplasmic antibody (ANCA) was positive, with a perinuclear pattern of staining (P-ANCA), and . . . [Full Text of this Article]

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Dr. Robert W. Simms's Diagnosis

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