Question 2 of 118
A 47-year-old man with a history of chronic sinusitis presents with shortness of breath to the EmergencyDepartment. Initial investigations reveal:
Hb 10.4g/dlPlatelets 477 * 10
/lWCC 14.3 * 10
/lESR 92 mm/hUrea 20 mmol/lCreatinine 198 µmol/lUrine dipstick blood +++
What is the most likely diagnosis?
Haemolytic uraemic syndrome
Next questionThe combination of pulmonary and renal involvement combined with a history of chronic sinusitis points towardsa diagnosis of Wegener's granulomatosis.
Wegener's granulomatosis is an autoimmune condition associated with a necrotizing granulomatous vasculitis,affecting both the upper and lower respiratory tract as well as the kidneysFeatures
upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
glomerulonephritis ('pauci-immune', 80% of patients)
saddle-shape nose deformity
also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions