A 57-year-old man was admitted to the clinic because of weight loss and persistent dry cough 4 months ago. Chest computed topography showed bilateral multiple infiltrates in the upper lobes and thickened bronchial walls. There is a documented positive serum MPO-ANCA in his medical record. Transbronchial biopsy revealed necrotic granulomas with multinucleated giant cells and the Wegener's granulomatosis was diagnosed for him. He is treating with corticosteroid and cyclophosphamides since 4 months ago. His Birmingham Vasculitis Activity Score (BVAS) is above 4 since the beginning of his disease. His last physical exam and lab study was performed yesterday and showed the results bellow:
A wellbeing, well-nourished man, non-icteric, cooperative and alert
Weight: 73 kg
Height: 177
BP: 120/80
HR: 90/min
RR: 22/min
Hgb: 13 g/dl
WBC: 8000 /mm3 (Neutrophil: 2700/mm3)
Plt: 300000 /ml
AST: 40 U/L
ALT: 56 U/L
Alk P: 147 U/L
Bill total: 1.2 mg/dl
ESR: 120 mm/hr
MPO-ANCA: 153 EU