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A 44-year-old man presented with intermittent epistaxis, fever, and polyarthralgias of 2 months' duration. For the previous week, he had had puffiness of the face and reduced urinary output. On physical examination, the blood pressure was 180/100 mm Hg; he was pale and had pedal edema. A saddle nose deformity (Panel A) had developed during the previous 4 months. There were no clinical signs of sinus involvement, but computed tomography (CT) showed bilateral mucosal thickening in the maxillary sinuses. Laboratory evaluation revealed the following values: hemoglobin, 7.5 g per deciliter; blood urea nitrogen, 163 mg per deciliter (58 mmol per . . . [Full Text of this Article] |
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