Page 11 / Case
ENT consult for biopsy; blood work to investigate for inflammatory involvement (CBC, ESR, CRP, rheumatoid factor, angiotensin converting enzyme, ANCA) and immunodeficiency (IgG/A/M); mantoux to help rule out TB; urinalysis to asses for renal involvement if Wegener's.
Otolaryngology was consulted for biopsy of the sinuses and tissue involved in the subglottic stenosis.
Operative report:
Gross inspection - sinuses: irregular solid (rubbery) tissue in middle meati bilaterally; subglottic stenosis: irregular mucosa, concentric, 0.5-1cm long
Further investigations:
CBC & differential: Hb 137, White blood cells 7.4 (eosinophils 0.3), platelets 270
chemistry: Na 140, K 3.9, Cl 105, Ca 2.40, urea 4.0, Cr 42, ALP 198
ESR 14 (normal 0-10), CRP 16.0 ( normal 0-8)
Mononucleosis spot negative
IgG 7.62, IgM 0.96, IgA 0.92
Rheumatoid factor 7 ( normal 0-20)
Angiotensin converting enzyme 24 ( normal 13-100)
ANCA:
Positive - cytoplasmic staining pattern (c-ANCA)
Anti-MPO < 2.0; Anti-PR3 26.5 (Normal < 5.0; indeterminate 5-15; positive > 15)
ANA: positive, 1:40, speckled pattern
Mantoux negative
Urinalysis: Specific gravity 1.015, pH 7.0 leukocytes/nitrites/protein/glucose/ketones/blood - all negative negative
Interpret the lab results.
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ANSWER
ENT consult for biopsy; blood work to investigate for inflammatory involvement (CBC, ESR, CRP, rheumatoid factor, angiotensin converting enzyme, ANCA) and immunodeficiency (IgG/A/M); mantoux to help rule out TB; urinalysis to asses for renal involvement if Wegener's.
Otolaryngology was consulted for biopsy of the sinuses and tissue involved in the subglottic stenosis.
Operative report:
Gross inspection - sinuses: irregular solid (rubbery) tissue in middle meati bilaterally; subglottic stenosis: irregular mucosa, concentric, 0.5-1cm long
Further investigations:
CBC & differential: Hb 137, White blood cells 7.4 (eosinophils 0.3), platelets 270
chemistry: Na 140, K 3.9, Cl 105, Ca 2.40, urea 4.0, Cr 42, ALP 198
ESR 14 (normal 0-10), CRP 16.0 ( normal 0-8)
Mononucleosis spot negative
IgG 7.62, IgM 0.96, IgA 0.92
Rheumatoid factor 7 ( normal 0-20)
Angiotensin converting enzyme 24 ( normal 13-100)
ANCA:
Positive - cytoplasmic staining pattern (c-ANCA)
Anti-MPO < 2.0; Anti-PR3 26.5 (Normal < 5.0; indeterminate 5-15; positive > 15)
ANA: positive, 1:40, speckled pattern
Mantoux negative
Urinalysis: Specific gravity 1.015, pH 7.0 leukocytes/nitrites/protein/glucose/ketones/blood - all negative negative
Interpret the lab results.
Next page /