PRTN3 and Acute otitis media: After an extensive work-up, considering the otorhinolaryngologic manifestations (acute otitis media with mastoid involvement, nasal ulcers, chronic atrophic rhinitis, mixed hearing loss), the pulmonary lesions (solitary pulmonary nodule situated in the superior lobe of the right lung, Fig. 1), the renal impairment (microalbuminuria), the left knee arthritis, the high blood levels of inflammation markers and antineutrophil cytoplasmic antibodies (c-ANCA), the diagnostic criteria for active systemic granulomatosis with polyangiitis were met.