Case Presentation: A 48-year-old Columbian woman presented with 5 weeks of malaise, epistaxis, and hemoptysis. Physical exam was relevant for fever, conjunctival injection, hoarseness, coarse breath sounds, tachycardia, mononeuritis, trace lower extremity edema, and no stigmata of thrombotic microangiopathy (TMA). Labs were significant for a creatinine of 2.8, leukocytosis, thrombocytosis of 992×103, and microscopic hematuria. [...]