Patient presents with suspected Granulomatosis with Polyangiitis (GPA), formerly known as Wegener's granulomatosis.  Presenting symptoms include persistent cough, hemoptysis, sinusitis refractory to standard treatment, and fatigue.  Physical examination reveals saddle nose deformity and palpable purpura on the lower extremities.  Laboratory findings show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), positive cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) with a cytoplasmic staining pattern targeting proteinase 3 (PR3-ANCA).  Chest radiography demonstrates multiple pulmonary nodules and infiltrates.  Based on these findings, the diagnosis of Granulomatosis with Polyangiitis is highly suspected.  Differential diagnoses include other vasculitides such as microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome).  A biopsy of the affected tissue (lung or sinus) is planned to confirm the diagnosis.  The patient's current medications include over-the-counter analgesics.  Treatment plan includes initiation of high-dose corticosteroids (e.g., prednisone) and immunosuppressive therapy with cyclophosphamide or rituximab, pending biopsy results.  Patient education provided regarding the disease process, treatment options, potential side effects of medications, and the importance of follow-up appointments for monitoring disease activity and treatment response.  Referral to a rheumatologist and nephrologist will be made for ongoing multidisciplinary care.  ICD-10 code M31.3 (Granulomatosis with polyangiitis [Wegener's]) applies.  Future evaluations will focus on monitoring renal function, pulmonary function tests, and ANCA titers.