Step 2

Rheumatology 6

A 70-year old-man presents to his primary care physician to discuss intermittent fevers, fatigue, bloody cough, frequent bloody noses, and red urine, which he has noticed over the last six months. His medical history is significant for an episode of otitis media four months ago, which was treated with antibiotics and is now resolved. Vital signs are within normal limits. Physical examination is significant for a perforated nasal septum. Recent purified protein derivative (PPD) and interferon gamma release assay (IGRA) were both negative for tuberculosis. A chest x-ray reveals large nodular densities. Urinalysis reveals the presence of hematuria but is otherwise negative.

Which of the following laboratory findings is most likely present in this patient?

  • A) Negative anti-neutrophilic cytoplasmic antibody (ANCA)
  • B) Positive anti-Saccharomyces cerevisiae antibodies (ASCA)
  • C) Positive cytoplasmic anti-neutrophil cytoplasmic antibody (cANCA)
  • D) Positive IgM autoantibody against the Fc portion of IgG
  • E) Positive perinuclear anti-neutrophil cytoplasmic antibody (pANCA)


Alexandra Conway


Dr. Ted O'Connell