Chest Pain, Cough, and Hemoptysis

An 18-year-old male presented with a 2-day history of left-side anterior chest pain. The pain was intermittent, crampy, and worsened with exertion. Associated symptoms were cough with sputum, night sweats, fever, decreased appetite, and 4.5-kg weight loss; cavitary lesions were seen on chest radiograph. The patient also had significant dental caries. Nasal biopsy revealed findings consistent with Wegener's granulomatosis. Combined treatment with cyclophosphamide and prednisone significantly improved his symptoms over the long term.