A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and hematuria and epistaxis for one & half months her hemoglobin is 7 gm. B.P.-->170/100, ptoreinuria +++, RA - ve and ANCA - ve. the likely cause is

Ans. is 'a' Wegener's granulomatosis Once again a question with 2 very close options. Here the confusion is between Wegener's granulomatosis and Good Pasteur's syndrome.I am more in favour of Wegener's granulomatoses comatose because of the following reasons - (1) 25 yrs old female - Good Pasteur's disease is 4 times more common in males. (2) presence of serous otitis media; presence of sinusitis, serous otitis media and other upper respiratory tract infections are classical features of Wegener 's granulomatosis. Upper respiratory tract infections can he present in good Pasteur's syndrome hut sinus involvement is not seen in Good Pasteur's Syndrome.Hypertension. Hypertension is unusual in good Pasteur's syndrome. It is seen in less than 20% cases ofGood Pasteur's Syndrome where as it is common in Wegener's Granulomatosis (d/t renal involvement).The factor which goes against the diagnosis of Wegener's granulomatoses is absence of CANCA. CANCA is present in about 95% of patients with Wegener's granulomatosis having renal involvement.Frankly speaking, I am not sure of the answer myself. You will have to decide on your own on this one, I will go for Wegener's granulomatosis.[Also go through Question No. 65/ Section XI Disorders of the immune system connective tissue and joints of Harrison's Pretest (15/e)l