Question

The most likely diagnosis in a patient with multiple pulmonary cavities, haematuria, and red cell casts is

• A. Anti-GBM disease
• B. Churg-Strauss allergic granulomatosis
• C. Systemic lupus erythematosus
• D. Wegener's granulomatosis

Hint:

Focus on which vasculitis specifically causes cavitating lung nodules, not just diffuse lung bleeding.

Answer 1

The Correct Option is D

This question is testing recognition of the classic triad of a specific ANCA-associated vasculitis from its lung and kidney findings.

1. Anti-GBM disease: gives diffuse alveolar haemorrhage with widespread lung infiltrates, not discrete cavitating nodules, so it is ruled out.
2. Churg-Strauss allergic granulomatosis: needs a background of asthma and eosinophilia and rarely causes cavitation or severe renal disease, none of which is mentioned here, so it is ruled out.
3. Systemic lupus erythematosus: can cause red cell casts from lupus nephritis but its lung disease is pleural or interstitial, not cavitating nodules, so it is ruled out.
4. Wegener's granulomatosis: multiple cavitating lung nodules plus a pauci-immune glomerulonephritis with red cell casts is its textbook presentation, and it is the classic c-ANCA/PR3-positive vasculitis, so this is the correct choice.

Correct answer: Wegener's granulomatosis.