MRCP2-4448

MRCP2-4448

A 30-year-old female with a history of sinusitis and asthma for four years presents with a fever, ankle swelling, and new onset dyspnea. She also reports blood streaks in her sputum for the past two weeks. On examination, she has widespread wheeze and bi-basal crepitations in her chest. Her oxygen saturation improves with treatment. She has a raised JVP, pitting edema up to her knees, and a heart rate of 112 beats per minute. Blood tests show a low hemoglobin level, high white cell count and eosinophil count, and elevated platelet count and CRP. Her serum sodium and potassium levels are abnormal, and her creatinine and urea levels are high. Blood cultures show coagulase-negative staphylococci, and ANCA positive immunostaining is awaited. A urine dip test is positive for protein and blood, and a chest X-ray shows bi-basal non-specific shadowing. What is the most likely diagnosis?