A 47-year-old woman with a history of myeloperoxidase–anti-neutrophil cytoplasmic autoantibody (MPO-ANCA) microscopic polyangiitis (MPA) in remission, left orbital plasmacytoma in remission, and hypothyroidism presented to the hospital for 1 month of persistent bilateral flank pain. Additionally, she had 2 months of migratory joint pain and a rash that was briefly treated with hydroxychloroquine. Treatment was discontinued because of gastrointestinal upset. Upon evaluation, she also had complaints of mild sinus congestion and right ear fullness, but denied any shortness of breath, fever, chills, cough, hemoptysis, dysuria, urinary frequency and urgency, or routine use of protein pump inhibitors, nonsteroidal anti-inflammatory drugs, diuretics, herbal supplements, or illicit drugs.
A 47-year-old woman with a history of myeloperoxidase–anti-neutrophil cytoplasmic autoantibody (MPO-ANCA) microscopic polyangiitis (MPA) in remission, left orbital plasmacytoma in remission, and hypothyroidism presented to the hospital for 1 month of persistent bilateral flank pain. Additionally, she had 2 months of migratory joint pain and a rash that was briefly treated with hydroxychloroquine. Treatment was discontinued because of gastrointestinal upset. Upon evaluation, she also had complaints of mild sinus congestion and right ear fullness, but denied any shortness of breath, fever, chills, cough, hemoptysis, dysuria, urinary frequency and urgency, or routine use of protein pump inhibitors, nonsteroidal anti-inflammatory drugs, diuretics, herbal supplements, or illicit drugs.