A65-year-old male adult presents with chronic sinusitis, nasopharyngeal ulcers, cavitatory lung nodules and renal failure. What will be the appropriate next diagnostic step?

Ans: C. ANCA and evaluation for vasculitis(Ref Harrison 19/e p2182-2184, 18/e p2786, 2789)Suggestive of Wegener's Granulomatosis.Wegener's Granulomatosis:c-ANCA positive small vessel vasculitis. levels are required for diagnosis.Tests:Specificity of a positive antiproteinase-3 ANCA for granulomatosis with polyangiitis (Wegener's) is very high, especially if active glomerulonephritis is present.However, the presence of ANCA should be adjunctive and, with rare exceptons, should not substitute for a tissue diagnosis.