A 54 yr old smoker man comes with fever, hemoptysis. weight loss and oligo ahritis. Serial skiagram shows fleeting opacities. What is the diagnosis aEUR'

Wegner's granulomatosis On first instance, presence of fleeting opacities and hempotysis makes it look like a case of allergic bmnchopulmona n, aspergillosis. But presence of oligoahritis and weight loss cannot be explained by allergic bronchopulmonary aspergillosis. Presence of fever, hemoptysi.s and weight loss suggests T.B. or carcinoma. But these two diseases cannot explain fleeting opacities and oligoahritis The chest X-ray appearance in carcinoma lung is usually a peripheral or central pulmonary mass depending upon the type of Ca. (Fleeting opacities are not associated with lung Ca). Fleeting opacities are not associated with T.B. too Besides allergic bronchopulmonary aspergillosis, the other option that may show presence of fleeting opacities in chest X-ray is "Wegner's granulomatosis". Chest X-ray of Wegner granulomatosis. "Lesions occur in any pa of the respiratory tract and take the form of inflammatory necrosis in the walls of small aeries and granulomatous masses upto several centimetres in diameter are apparent on chest-xray. These are fairly well defined and they often cavtate; the lesion may resolve spontaneously while new masses appear. There is considerable day to day variability and eventual total resolution of these abnormalities occur after t/t with prednisolone and cyclophosphomilase" About oligoahritis and weight loss Both the above mentioned features are seen in wegner's granulomatosis. Wegener's granulomatosis presents with nonspecific constitutional symptoms such as fatigue, myalgia, weight loss and fever. Joint involvement in wegner's granulomatosis take the form of pauci or polyaicular ahritis.