A 50-year-old man presents with hemoptysis, sinusitis, and hematuria. Chest CT shows multiple cavitary lung nodules. c-ANCA (PR3-ANCA) is positive. Lung biopsy shows necrotizing granulomatous inflammation of the respiratory tract and focal necrotizing glomerulonephritis. Which vasculitis is most likely?

• A Microscopic polyangiitis
• B Granulomatosis with polyangiitis (Wegener granulomatosis) ✓
• C Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
• D Polyarteritis nodosa

Explanation

Granulomatosis with polyangiitis (GPA, formerly Wegener) is the classic triad of upper airway, lower respiratory tract, and renal involvement with necrotizing granulomas. c-ANCA/PR3 positivity supports the diagnosis. Microscopic polyangiitis is p-ANCA positive and lacks granulomas. EGPA has asthma and eosinophilia. PAN does not involve lungs or cause glomerulonephritis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.