Rheumatology and Musculoskeletalmiddle twist
A 67-year-old man has recurrent sinusitis, otitis and a persistent cough with occasional blood-streaked sputum. Urinalysis shows dysmorphic red cells and red-cell casts, serum creatinine is 245 micromol/L (reference range 60–110), and chest imaging shows multiple pulmonary nodules. Testing is positive for proteinase-3 ANCA, and he reports a remote history of bladder cancer. Which induction treatment is most appropriate?