Differential Diagnosis

The patient's presentation with pulmonary hemorrhage, glomerulonephritis, history of sinusitis, and numbness in the right upper limb and left lower limb suggests a systemic vasculitis. Here's a categorized differential diagnosis:

• Single most likely diagnosis

  • C. Granulomatosis with polyangiitis (GPA): This condition, formerly known as Wegener's granulomatosis, is a form of vasculitis that affects small- and medium-sized vessels. It often presents with a combination of respiratory (such as sinusitis and pulmonary hemorrhage) and renal (glomerulonephritis) symptoms, along with systemic symptoms. The patient's history of sinusitis and the presence of both pulmonary hemorrhage and glomerulonephritis make GPA a strong consideration.

• Other Likely diagnoses

  • B. HSP (Henoch-Schönlein Purpura): Although more common in children, HSP can occur in adults and is characterized by palpable purpura, abdominal pain, arthralgias, and renal involvement. However, pulmonary hemorrhage is less common in HSP, making it less likely than GPA in this case.
  • A. Giant cell arteritis: This large vessel vasculitis primarily affects the elderly, presenting with symptoms like headache, jaw claudication, and visual disturbances. While it can have systemic manifestations, the patient's age and specific symptoms (pulmonary hemorrhage, glomerulonephritis, and the pattern of numbness) are not typical for giant cell arteritis.

• Do Not Miss

  • Goodpasture syndrome: This is an autoimmune disease characterized by the presence of anti-GBM antibodies, leading to glomerulonephritis and pulmonary hemorrhage. It's a critical diagnosis to consider due to its potential for severe and rapid progression, despite being less common.
  • ANCA-associated vasculitis (not limited to GPA): This includes conditions like microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). These vasculitides can present with overlapping symptoms, including renal and pulmonary involvement, and are important to distinguish due to differences in treatment and prognosis.

• Rare diagnoses

  • Ehlers-Danlos syndrome with vascular involvement: While primarily known for its effects on skin and joints, certain types of Ehlers-Danlos syndrome can involve vascular fragility, potentially leading to hemorrhagic complications. However, the combination of pulmonary hemorrhage, glomerulonephritis, and the specific pattern of numbness would be unusual.
  • Relapsing polychondritis: This rare autoimmune disorder can affect various tissues, including the respiratory tract and potentially lead to vasculitic manifestations. However, it would be an uncommon explanation for the patient's specific constellation of symptoms.