A 29-year-old woman presented to our rheumatology clinic with a 6-month history of cough, dysphonia, dyspnoea and weight loss. She also complained of a lump in her throat (globus pharyngeus), left otalgia and hearing loss. One month before evaluation, she started experiencing blood-tinged sputum and dyspnoea. On clinical examination, the patient had nasal discharge, crusting and congestion, laryngeal oedema, stridor, tympanic membrane retraction and external auditory canal ecchymosis.

Laboratory findings showed anaemia (haemoglobin: 75.4 g/L, normal: 122.0–181.9), lymphocytosis 4.63×109/L (normal: 0.60×109–3.4×109/L), C reactive protein 13 mg/L and erythrocyte sedimentation rate 10 mm/hour. Serum creatinine level and urinalysis with urine …