Syed Irfan Ahmed, Muhammad Naseemullah, Aisha Sheikh.
Wegener`s Granulomatosis in the guise of HLA B-27 positive Arthritis with Uveitis and Lung abscess.
J Pak Inst Med Sci Jan ;13(2):707-9.

A 27 year old gentleman presented with painful joint swelling, progressive diminution of vision, high grade fever and cough. Two years back he had developed painful swelling of joints. This started from the ankle joints and progressively involved the knee, wrist, shoulder and hip joints. The pain was severe enough to interfere with his daily activities. NSAIDs only provided temporary relief. Two months later he developed redness of both eyes and progressive diminution of vision. He consulted a local eye specialist who diagnosed uveitis and ordered ESR and Rheumatoid factor. The ESR exceeded 100mm while Rheumatoid factor was negative. He was further advised to have his HLA B-27 status determined. This turned out positive. He was prescribed corticosteroids, both tablets and eye drops, while NSAIDs were continued. This did not result in significant improvement either. For the last two months he was running high-grade fever and had a productive cough. The sputum was mucoid. Fever transiently responded to antipyretics. Investigations revealed a total leucocyte count of 25000/cmm showing predominantly neutrophils. The ESR was still markedly elevated. Chest radiographs showed a large opacity in the right upper and middle zones with evidence of cavitation. Fever persisted, the cough remained productive and vision continued to deteriorate. There was also a steady weight loss. This however, had not been documented. He was referred to Holy Family Hospital and admitted. Patient was treated symptomatically, tuberculosis could not be ruled out and CT Scan chest ordered. CANCA found to be positive and diagnosis of Wegener`s Granulomatosis was made.

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