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A 64-year-old Finnish man was admitted to hospital because of abdominal pain and macroscopic haematuria. The pain, located in the right upper quadrant, had been continuous for 48 h. On physical examination, the findings of pulmonary and cardiac auscultation were normal. No peripheral oedema, skin rash or neurological signs were observed. His abdomen was soft, but tender, on the upper right quadrant. Findings of rectal palpation, bowel sounds and chest radiograph were normal. The body temperature was 37.8°C, and blood pressure was 146/96 mmHg. The medical records revealed a diagnosis of asthma 15 years earlier and a nasal polypectomy 2 years earlier.
The laboratory results showed elevated plasma C reactive protein (80–230 mg/l) and creatinine (267 μmol/l). Haemoglobin level (146 g/l) was normal, but a blood count indicated leucocytosis (14.0×109/l). Blood eosinophil count was elevated (0.50×109/l; normal range 0.05×109/l to 0.44×109/l). Platelet and erythrocyte counts were in the normal range (237×109/l and 4.8×1012/l, respectively). Liver function tests (plasma aminotransferases, alkaline phosphatase and bilirubin) and plasma amylase level were also normal. Serum anti-neutrophil cytoplasmic antibody titre and anti-proteinase 3 antibodies were in the normal range. However, serum perinuclear-staining anti-neutrophil cytoplasmic antibody titre was slightly elevated (320) together with substantially elevated serum antibodies for myeloperoxide (150 EU; normal range <10 EU) and serum IgE (658 kU/l; normal range <100 kU/l). Urine …