20th February 2025

A 42-year-old man with no significant medical background presents with a few months’ history of night sweats, weight loss, arthralgia, recurrent sinusitis, earache and cough with white sputum.

A 42-year-old man with no significant medical background presents with a few months’ history of night sweats, weight loss, arthralgia, recurrent sinusitis, earache and cough with white sputum. Recently, he has noted some blood in his sputum and worsening breathlessness. Incidentally, he reports some blood in his urine. His face in profile is shown below.

His observations are normal apart from a blood pressure of 174/95 and a respiratory rate of 24. His urine dipstick is positive for blood (3+) and protein (1+) and leucocytes. Nitrites are negative.

Bloods show an iron-deficiency anaemia, raised white cells with a normal eosinophil count. His CRP is 56 mg/L (normal: < 10 mg/L). His platelets are raised and clotting screen normal. The creatinine is 196 micromol/L (no prior renal function on record as baseline; normal: 55-120 micromol/L). His c-ANCA is 15 IU/mL (negative is <2.0). His p-ANCA is not detectable.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.