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Our patient was treated with prednisone 1mg/kg daily and methotrexate 25mg S.C. weekly, with monthly monitoring of renal function, ESR/CRP and ANCA. His voice had improved, and his SOB resolved, by Day 3 of prednisone therapy. On follow-up by Rheumatology 2 weeks post-discharge, he was started on a tapering dose of prednisone. When seen by Pulmonary one week later, he was found to have a normal voice, no SOB and no stridor. He did have purulent nasal discharge, and was prescribed a course of azithromycin. Pulmonary function testing showed normalization of the shape of the flow-volume loop, FEV1 and PEF. In addition, his ESR, CRP and anti-PR3 levels have improved. His urinalysis remained normal. When seen again 9 weeks post-discharge, he remained well. The plan is to continue to wean his prednisone slowly, continue his methotrexate, and repeat a CT chest and sinuses at approximately 5 months post-discharge.
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Our patient was treated with prednisone 1mg/kg daily and methotrexate 25mg S.C. weekly, with monthly monitoring of renal function, ESR/CRP and ANCA. His voice had improved, and his SOB resolved, by Day 3 of prednisone therapy. On follow-up by Rheumatology 2 weeks post-discharge, he was started on a tapering dose of prednisone. When seen by Pulmonary one week later, he was found to have a normal voice, no SOB and no stridor. He did have purulent nasal discharge, and was prescribed a course of azithromycin. Pulmonary function testing showed normalization of the shape of the flow-volume loop, FEV1 and PEF. In addition, his ESR, CRP and anti-PR3 levels have improved. His urinalysis remained normal. When seen again 9 weeks post-discharge, he remained well. The plan is to continue to wean his prednisone slowly, continue his methotrexate, and repeat a CT chest and sinuses at approximately 5 months post-discharge.
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