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A 33-year-old woman presented with malaise, bloody nasal discharge, nasal crusting, and arthralgia. On examination, disconjugate gaze and protrusion of the right eye with scleritis were found. Serologic evaluation revealed elevated acute-phase reactants. Antineutrophil cytoplasmic antibodies (ANCA) with a cytoplasmic pattern, at a titer of 1:256, were positive on direct immunofluorescence staining, and the level of ANCA directed against proteinase 3 was more than 100 U per milliliter in an enzyme-linked immunosorbent assay (normal value, <5). Examination of a sinus-biopsy specimen revealed granulomatous inflammation with geographic necrosis, and Wegener's granulomatosis was diagnosed. Therapy with cyclophosphamide and prednisone was initiated. Increasing . . . [Full Text of this Article] |
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