A 45-year-old male presents to his physician complaining of achy joints,chronic runny nose,and coughing up blood.Chest x-ray shows pulmonary infiltrates.Cortisol is increased; erythrocyte sedimentation rate (ESR)is slightly elevated.Tests for autoantibodies are positive for antineutrophil cytoplasmic antibodies.On the basis of these findings,a likely diagnosis for this patient is:

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The symptoms of achy joints, chronic runny nose, coughing up blood, and pulmonary infiltrates suggest a diagnosis of Wegener's granulomatosis, which is a type of vasculitis affecting the small vessels of the respiratory system and kidneys. The increased cortisol and positive antineutrophil cytoplasmic antibodies (ANCA) further support this diagnosis. Systemic lupus erythematosus and rheumatoid arthritis can cause joint pain, but do not typically present with respiratory symptoms such as coughing up blood or pulmonary infiltrates. Chronic granulomatous disease does not typically present with these symptoms either.

A 45-Year-Old Male Presents to His Physician Complaining of Achy