Picture Quiz

A 78 year old has swinging pyrexia. He has had a laparoscopic cholecystectomy complicated by gastrointestinal perforation and postoperative multiorgan failure two weeks previously. On examination his temperature was 39°C, pulse 100/min and irregularly irregular, blood pressure 120/80 mm Hg. He has an impaired percussion note and bronchial breathing at the right base.

Wegener's granulomatosis involves mainly the upper respiratory tract, lungs, and kidneys. It responds well to treatment with cyclophosphamide and corticosteroids.

Churg-Strauss syndrome is characterised by eosinophilic infiltration of the lungs, peripheral nerves, and skin. It responds well to corticosteroids.

Microscopic vasculitis (polyangiitis) results in haemoptysis and involves usually the lungs and kidneys.