20th February 2025

A 78-year-old woman presents to hospital with worsening breathlessness, nausea, general malaise and fever over the past 5 weeks.

A 78-year-old woman presents to hospital with worsening breathlessness, nausea, general malaise and fever over the past 5 weeks. She has also noticed some crusting of the skin around the nostrils.

On examination, she has bilateral crepitations on auscultation of the lungs.

Her bloods show a raised white cell count and CRP of 68 mg/L (normal <10 mg/L). Her creatinine is 228 micromol/L (normal: 55-120 micromol/L). Her urine dip shows 3+ blood and 2+ protein. Her c-ANCA is negative and her p-ANCA is positive.

What is the most likely diagnosis?

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