A man with Wegener's granulomatosis and haemoptysis

Abstract

A 60 year old man with Wegener’s granulomatosis who was clinically stable on methotrexate presented with a two day history of haemoptysis. On examination he was febrile, with bibasal crepitations and bronchial breath sounds in the left upper zone. Pulse oximetry showed an oxygen saturation of 96% on air. A full blood count showed that his haemoglobin was 134 g/l, white blood cells were 18.4×109/l (neutrophils 15.3×109/l), and serum creatinine was 74 μmol/l. He had a titre of 1:160 on recent serological testing for cytoplasmic staining antineutrophil cytoplasmic antibodies. Urinalysis detected trace amounts of protein and blood, but he had no dysmorphic red cells or casts on urine microscopy. He underwent computed tomography of the chest and chest radiography (figs 1⇓ and 2⇓). Fig 1 Chest radiograph Fig 2 Computed tomography of the chest ### Short answers Fig 3 Chest radiograph showing bibasal and right upper lobe air space shadowing Fig 4 Computed tomography of the chest confirming bilateral air space infiltrates (arrowheads) and surrounding ground glass shadowing