Abstract
<h3>SELECTED CASES</h3><h3>Patient 1</h3> A previously healthy 20-year-old man experienced the subacute onset of an influenzalike illness characterized by diffuse arthralgias, malaise, fever, nonproductive cough, nasal congestion, epistaxis, and frontal headaches. His symptoms were unresponsive to decongestants and multiple courses of oral antibiotics. During the next several weeks he developed pain and swelling over the bridge of his nose and migratory pain and swelling of multiple joints. Because of persistent epistaxis he consulted an otolaryngologist, who noted diffusely inflamed nasal mucosa and performed a biopsy, which showed acute and chronic inflammation. The patient was referred to the National Institutes of Health 4 months after his symptoms began. Laboratory evaluation showed a white blood cell count of 10.8×10<sup>9</sup>/L, hemoglobin of 126 g/L, erythrocyte sedimentation rate of 71 mm/h, creatinine of 80 μmol/L (0.90 mg/dL), and a normal urinalysis. Radiographic studies revealed pansinusitis and a nodule in the upper lobe
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