Concluded Case

Granulomatosis due to polyangitis

A 73 year old female presented with breathlessness which is aggravated on exertion, associated with productive cough.she also c/o head ache and has a remote h/o migratory arthralgia,joint effusion,fever and ulcerative colitis(diagnosed by colonoscopy).Her personal history is significant for smoking.There is no H/o recent travel o/e:There is conjunctivitis in the right eye with proptosis and exopthalmos.she is afebrile urinalysis is positive for hematuria & sputum culture,C-ANCA and P-ANCA are negetive what is the most likely diagnosis in this case?

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Concluded answer
This shows TB like picture with dyspnea, productive cough,h/o smoking with migratory arthralgia inflammatory symptoms in eyes and gut indicate vasculitis and hematuria indicate micro vessel involvement C-ANCA may be negetive in 10-15 % cases this may be due to EGPA i.e granulomatosis due to polyangitis. f/s/o Wegner granulomatosis
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CH SMOKER SOB PRODUCTIVE COUGH SPTUM CULTURE NO GROWTH FEVER 0 HEADACHE + PAST = UC EXOPTHALMOS RT EYE PROPTOSIS+ RT CONJUNCTIVITIS + RT CXR.= CAVITY LESION RT UPPER ZONE IRREGULAR THICK OUTLINE WITH NODULAR CENTRE TRACHEA DIVIATED TO LT LEFT HILUM PROMINENT CARDIOMEGALY + CA RT LUNG WITH RETROBULBAR METASTASIS ADV PET SCAN CT MRI RT ORBIT URINE HAEMATURIA POSSIBLY RENAL METASTASIS
Thank you doctor
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This shows TB like picture with dyspnea, productive cough,h/o smoking with migratory arthralgia inflammatory symptoms in eyes and gut indicate vasculitis and hematuria indicate micro vessel involvement C-ANCA may be negetive in 10-15 % cases this may be due to EGPA i.e granulomatosis due to polyangitis. f/s/o Wegner granulomatosis
Sternal sutures in situ. Bil half filled cavities noted. Rheumatoid lung Or lung abscess.

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