's Granulomatosis(WG) is a rare type of multisystem small to medium vessel vasculitis with necrotizing granulomatous inflammation involving the upper airway, lungs and the kidneys. In generalized WG, patient invariably dies within few months if left untreated. The key to better prognosis is early treatment once the diagnosis is made.Our patient is a 21yr young lady who was initially diagnosed as nasal septal abscess and later as pulmonary tuberculosis. She was treated accordingly but did not improve.When presented to us, she had asymmetric polyarthritis, cough with mucoid expectoration, intermittent mild haemoptysis as well as fever with bilateral nasal obstruction and epistaxis of about 2 months duration. She was found to have saddle nose deformity with blocked nasal passage and easily bleeding nasal crusts. Bilateral episcleritis and oral aphthous ulceration were also present. Chest X-Ray showed bilateral consolidations and infiltrates. Her hemoglobion was 6.42 gm% with high ESR and CRP. Microscopic haematuria with high serum creatinine and strongly positive C-ANCA were also found. MRI showed rt maxillary sinusitis and right mastoiditis.

We report a case of middle aged man who presented with inflammatory low back pain with restriction of movement and enthesopathy. Later on the developed inflammatory pain affecting small and large joints of upper and lower limbs associated with morning stiffness with deformities. There is also positive family history. So, though the incidence is very rare the coexistence of rheumatoid arthritis and ankylosing spondylitis in this case would be a possibility.

Wegener's granulomatosis (WG) is an uncommon condition characterized by necrotizing granulomatosis of the upper and lower respirator y tract and glomerulonephritis. We describe a case of a 23-year-old man with symptoms of frequent nasal discharge with bleeding and occasional cough with blood. In this report, we wanted to emphasize that Wegener's granulomatosis, although rare, should be considered in recurrent epitaxis.TAJ 2009; 22(1): 261-263