Considering (i) patient age, (ii) clinical conditions, (iii) disease progression, (iv) previous treatments, and (v) scientific literature reporting involvement of TNF pathway and response to anti-TNF agents in systemic vasculitis, off-label use of etanercept (Bartolucci et al., 2002; Sonomoto et al., 2008) was proposed (25 mg subcutaneously twice a week). The gene discussed is TNF; the disease is necrotizing vasculitis.