Case Outcome The patient was initially commenced on intravenous antibiotics, aspirin, clopidogrel and low molecular weight heparin (LMWH) for a putative diagnosis of community acquired pneumonia complicated by acute coronary syndrome. However, following review of the chest x-ray and careful evaluation of the history, the diagnosis of Wegener’s Granulomatosis (WG) was considered and immunological tests were requested (table 1). Prednisolone 60mg daily was commenced pending the urgent Anti Neutrophil Cytoplasmic Antibody (ANCA) result. A palpable purpuric rash then developed over the dorsal aspects of both feet. [download-attachments container="div" style="list" dipslay_icon="1" display_count="1" display__size="0"]