Case 126

 A seventy one-year-old male presented in our hospital for rhinitis continuing for approximately one month. He visited two local clinics but his symptoms did not improve. Nasal fiberscope revealed edematous nasal membrane with fragility and bleeding-tendency. There did not include not so much purulent fluid, suspicious of vasculitis. Body temperature was 38.7℃.

 Laboratory test revealed white blood cells 14860/mm³ neutrophils 87.5%, platelets 530000/ mm³, ALP 1151U/L (106-322), CRP 29.79mg/dL (<0.14), procalcitonin 0.38ng/mL (<0.50), MPO-ANCA negative, PR3-ANCA 89.2U/mL (<3.5). He received face CT and chest CT for further examination.

What is your diagnosis ?

1. Fungus pneumonia and sinusitis

2. Bacterial pneumonia and sinusitis

3. Metastatic pulmonary cancer from maxillary sinus cancer

4. Granulomatosis with Polyangiitis

answer

2018.10.24