Abstract
A 63-year-old man had a two-month history of nasal obstruction, epistaxis and purulent nasal discharge. He was given antibiotics at the Ear, Nose and Throat Department of our hospital, however, symptoms did not improve. He was admitted on April 1997, because his condition worsened progressively with productive-cough, hearing loss, otalgia and painful oral ulcers. Clinical picture showed sinusitis, ulcerative bronchitis and glomerulonephritis. A confirmatory diagnosis of Wegener's granulomatosis (WG) was made by elevated C-ANCA titer and histopathologic finding of nasal biopsy specimen. He was treated with daily cyclophosphamide and prednisolone. After standard treatment of WG, C-ANCA titer was withdrawn and the nasal lesion was improved immediately. However, because microhematuria and endobronchial lesions did not recover, he was treated with pulse therapy of methylprednisolone. After treatment of pulse therapy, microhematuria and the endobronchial lesion improved markedly. C-ANCA titer reflected overall disease activity, but not the endobronchial inflammatory activity of WG. Bronchofiberscopy was useful in the diagnosis and management of WG.
