Hx: 33 y M cocaine abuse history, admitted with 4 weeks of nasal obstruction, dysphagia, otalgia, nasal bridge deformity;Endoscopy: nasal corridor necrosis;CT head/chest: nasal cavity extensive bone destruction, multiple small pulmonary nodules;Lab: leukocytosis, high CRP, high ESR; c-ANCA+;Nasal biopsy: no vasculitis signs;Dx: CIMDL;Tx: counseling on cocaine cessation. Here, ESR1 is linked to Increased total leukocyte count.