<prompt> a young male develops serous otitis media of the left ear with cough, occassional hemoptysis, hematuria and epistaxis for 2months.hb is 7.5 g with heavy protienuria, bp 170100 mmhg, RA -ve and anca ve the most probable diagnosis iswegners granulomatosisrapidly proliferative glomerulonephritisrheumatoid ahritisgood pastures syndrome  <response>: Wegener Granulomatosis Triad of: -- Acute necrotizing granuloma of U or L -- Necrotizing or granulomatous vasculitis of small-medium vessels -- Renal disease: crescentic glomerulonephritis C-ANCA in 95 of cases Diagnosis -- cANCA 95 sensitive in generalized disease 60 sensitive in localized disease -- FBC, ESR, CRP, CXR, Urine analysis for casts -- Histology: Tissue from septum all turbinates -- CT nose paranasal sinuses Non-specific mucosal thickening; bony destruction; new bone formation DIAGNOSTIC CRITERIA ACR criteria 1990 2 of 4 Sensitivity 88, Specificity 92 1. Nasal or oral inflammation 2. Abnormal chest radiograph: nodules, fixed infiltrates, or cavities 3. Urinary sediment: Microhematuria 5 red blood cells HPF or RBC casts 4. Granulomatous inflammation on biopsy Histologic changes showing granulomatous inflammation within the wall of an aery or in the perivascular or extravascular areaaery ,aeriole CHCC nomenclature 1994 1. Granulomatous inflammation involving the respiratory tract 2. Vasculitis of small to medium-size vessels ref: harrisons 21st ed 