Lost in the Woods: Granulomatosis with Polyangiitis Lindsay T. Fourman, MD, Amy G. Fogelman, MD  The American Journal of Medicine  Volume 128, Issue 10, Pages 1080-1082 (October 2015) DOI: 10.1016/j.amjmed.2015.06.019 Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 1 The audiogram plots the lowest-intensity sound the patient is able to detect at each frequency. Normal hearing is −10 to +25 dB (shaded area), and speech frequencies typically range from 250 to 6000 Hz. Our patient had sloping to severe hearing loss in her right ear. Air conduction was worse than masked bone conduction, suggesting a significant conductive deficit. Bilateral moderate sensorineural hearing loss was also present, as was evidenced by the downward sloping of the masked bone conduction curves. The American Journal of Medicine 2015 128, 1080-1082DOI: (10.1016/j.amjmed.2015.06.019) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 2 Computed tomography of the chest showed multifocal tree-in-bud opacities (T) and bronchiectasis (B). The American Journal of Medicine 2015 128, 1080-1082DOI: (10.1016/j.amjmed.2015.06.019) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 3 Indirect immunofluorescence demonstrated a perinuclear staining pattern that was confirmed by immunoassay for myeloperoxidase antibodies. The American Journal of Medicine 2015 128, 1080-1082DOI: (10.1016/j.amjmed.2015.06.019) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 4 Urine microscopy was performed. The urine sediment contained red blood cell casts and dysmorphic red blood cells, suggestive of glomerulonephritis. The American Journal of Medicine 2015 128, 1080-1082DOI: (10.1016/j.amjmed.2015.06.019) Copyright © 2015 Elsevier Inc. Terms and Conditions