LATE RECURRENCE OF WEGENERS GRANULOMATOSIS PRESENTING AS TRACHEAL STENOSIS IN A RENAL-TRANSPLANT PATIENT

An unusual case of a 46-year-old man who had end-stage renal disease d ue to crescentic glomerulonephritis that was treated by a cadaveric re nal allograft is presented. About 18 months post-Tx, the patient devel oped severe tracheal stenosis which, on biopsy, revealed granulation t issue and chronic inflammation. After another 18 months he developed n ecrotizing glomerulonephritis involving the renal allograft and an inf lammatory retro-orbital pseudotumor. The latter, on biopsy, revealed g ranulomatous vasculitis characteristic of Wegener's granulomatosis. Th is diagnosis was further confirmed by strongly positive anti-neutrophi l antibodies with diffuse granular cytoplasmic immunofluorescence (C-A NCA). The patient was treated successfully with cyclophosphamide thera py.