Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of chronic upper and lower respiratory symptoms, including persistent nasal congestion, epistaxis, and crusting. Reports associated dyspnea, non-productive cough, and occasional hemoptysis. Systemic symptoms include malaise, fatigue, arthralgia, and unexplained weight loss. No history of recent travel or infectious exposures.
Clinical Examination Findings
HEENT: Nasal mucosal ulceration, septal perforation, and crusting observed. Oropharyngeal erythema noted. Lungs: Bilateral crackles or wheezing on auscultation. Skin: Palpable purpura or subcutaneous nodules noted on extremities. Joints: No acute synovitis or deformity. Neurological: No focal deficits or evidence of mononeuritis multiplex.
Treatment Protocol
Initiation of induction therapy with high-dose corticosteroids (prednisone) and immunosuppressive agents (Rituximab or Cyclophosphamide). Monitoring of renal function (creatinine, GFR) and urinalysis for hematuria/proteinuria. Prophylaxis for Pneumocystis jirovecii pneumonia (PJP) with trimethoprim-sulfamethoxazole. Regular follow-up for ANCA titer monitoring and assessment of treatment response.