CHRONIC SINUSITIS AND BEYOND. A. Loewen 1 ; 1 University of Calgary, Calgary, Alberta, Canada (Tracking ID #77075) LEARNING OBJECTIVES: To review an approach to the patient with chronic infection. To discuss the manifestations of Wegener's Granulomatosis. CASE INFORMATION: A 33 year old male with a 4 month history of chronic sinusitis which is refractory to antibiotics, and an episode of suppurative otitis media, presents with left sided Bell's palsy and multiple boils. There is microscopic hematuria with normal renal function. Drainage and biopsy of sinuses demonstrates necrotizing granulomatous inflammation. Anti PR3 level is 18.5 kEu/L. A diagnosis of Wegener's granulomatosis is made. The patient later develops hemoptysis while on therapy with prednisone and cyclophosphamide. IMPLICATIONS/DISCUSSION: An approach to the patient with apparently chronic infection must include infectious causes, underlying immunosuppressed states and noninfectious causes. Wegener's granulomatosis is a vasculitis of small arteries and veins and usually presents as a pulmonary-renal syndrome. In this case it presented with upper airway involvement, pyoderma gangrenosum and cranial nerve palsy, butpulmonary and renal symptoms were minimal. A broad differential diagnosis can lead to the correct diagnosis, avoiding unnecessary interventions, and hasten administration of appropriate therapy.