A 52-year-old man developed some flu-like symptoms

ENT
Case 13.
A 52-year-old man developed some flu-like symptoms that did not totally resolve and progressed to nasal stuffiness and a chronic non-productive cough. Physical examination revealed some crusting of the nasal mucosa but no other abnormalities of significance. Laboratory evaluation was normal except for a moderately elevated ESR. On chest x-ray there were ill-defined nodular densities in th upper midlung fields. Sputum cultures were later reported as negative for pathogenic organisms. A blood sample for antineurotrophic cytoplasmic antigen was obtained but the results were not available at the time of nasal biopsy. The nasal biopsy was non-contributory, showing only mild nonspecific chronic inflammation. ANCA antibody was elevated and an open lung biopsy was obtained (your slide).


Dx: Wegener's Granulomatosis - Lung Bx
good example x/ I don't see good vasculitis

Hx is a give away here.

men>women, 4th-5th decodes

sinonasal region is most common-may involve oral cavity, nasopharynx, larynx, ear, salivary glands
Sx's - nasal obstruction, epistatis, pain
systemic: lungs, kidneys, skin, orbit
Histo: vasculitis
Polymorphsus benign cellular infiltrate
Ischemic-type necrosis
Giant cells
(-) cultures
DDx: infection
lymphoma