Multiple pulmonary nodules. Wegener's granulomatosis simulating pulmonary metastases

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Abstract
A 52-year-old man was hospitalized with a history of dry cough, dyspnea and fever (38°C), evolving with vomiting and a palpable purpura on the left ankle. Chest examination identified crackles in the lungs bilaterally. Blood tests revealed anemia; creatinine, 9.7 mg/dl; urea, 174 mg/dl; potassium, 6.0 mEq/l; and erythrocyte sedimentation rate, 116 mm/h. Urine tests showed proteinuria (2+) and massive hematuria. A chest X-ray revealed perihilar infiltrates and right pleural effusion.