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A 70 year old male patient was admitted to the outpatient clinic because of chronic fatigue, weight loss, generalised joint aching, arthritis of the ankles, and renal insufficiency. His medical history was unremarkable. At physical examination, increased central venous pressure, subfebrile temperature of 38.4°C, tender and swollen ankles, and painful flexion and extension were observed. Laboratory investigation showed an erythrocyte sedimentation rate of 70 mm/1st h, haemoglobin 5.1 mmol/l, leucocytes 18.6×109/l, eosinophils 670×106/l, serum creatinine 369 μmol/l, urea 18.0 mmol/l, and urine sediment with 20–50 erythrocytes, 0–5 leucocytes, and several casts of the urinary tract epithelial lining. Positive tests for antineutrophil cytoplasmic antibodies with a cytoplasmic pattern (c-ANCA) and antigenic specificity for …
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