Clinical Conference A Case of Treated ANCA-Associated Vasculitis with Recurrent Renal Failure

The patient is a 45-yr-old Caucasian man with no significant past medical history, who in December 2006 developed arthralgias affecting both shoulders and hips and subsequently noticed short-ness of breath with a cough, and a lower limb rash. These symp-toms did not improve with diclofenac or with a course of antibi-otic therapy prescribed by his general practitioner. The patient presented to his local hospital when he developed hemoptysis, epistaxis, and sinusitis, as well as a worsening of his shortness of breath, rash. and arthralgias. He had lost 3.5 kg in weight during the course of his illness. He was on no medication except for diclofenac, prescribed in the previous month, and a course of amoxicillin. His family history included rheumatoid arthritis and lung cancer in two family members, both of whom were heavy smokers. Hewas originally from Ireland but had been living in the United Kingdom for the previous 25 yr. He had a partner an