Wegener's granulomatosis--another challenging case

A 54-year-old lady initially presented with mild dyspnoea, left-sided flank pain and bilateral leg swelling. She was diagnosed as having single vessel coronary heart disease. Subsequently, this lady developed malaise, joint aches, an aspecific skin rash and limbal conjunctivitis. She was thought to have Löfgren's syndrome. The patient then developed sore throats and petechiae, later severe dyspnoea with sanguineous expectoration and light nasal bleeds. Cytoplasm-antineutrophil cytoplasmic autoantibodies and proteinase 3-ANCA were determined, found positive and she was diagnosed as having Wegener's granulomatosis. This was at 3 months after her initial presentation. She was treated with pulsed intravenous Cyclophosphamide and oral prednisolone. The patient improved quickly and the medication was changed to oral methotrexate and prednisolone. Currently, the patient is doing well and is in remission.