Mortality among patients with Wegener’s granulomatosis (WG) is more likely among those with renal disease.^1,2 Among the non-renal causes, laryngeal involvement with airway obstruction is a rare but important preventable cause of death.³ Here, we describe a patient with WG and laryngeal involvement, in whom death occurred by inhalation of a nasal crust.

The patient, a 26 year old woman, first presented to us in 1998 with a 3 year history of intermittent stridor associated with hoarseness of voice, intermittent nasal stuffiness, nasal crusting, and recurrent sinusitis. Serum perinuclear antineutrophil cytoplasmic antibody was positive at a titre of 1/80 by indirect immunofluorescence, with myeloperoxidase-ANCA of 28 AU/ml (normal range 0–5) by enzyme linked immunosorbent assay (ELISA), while cytoplasmic ANCA was negative and proteinase 3-ANCA …