P/E: Saddle nose & multiple oral & nasal necrotizing ulcers.  Investigations showed,  Necrotizing granuloma: URT, lungs, kidney, skin.  Necrotizing vasculitis of small vessels in lungs.  c-ANCA positivity in the serum (>95% pts)  Cavitary lung nodules. Glomerulonephritis.  Males > females, age ~40y.  Ulcers, granulomas & sinusitis.  Immunosuppression, steroids