A 43-yr-old man with a 19-yr history of Wegener's granulomatosis presented with recurrent haematuria, pulmonary infiltrate, cutaneous vasculitis, nasal mucosal involvement and elevation of ANCA levels, 2 yr following successful cadaveric renal transplantation, despite continued immunosuppressive therapy with cyclosporine, azathioprine and prednisone. Re-introduction of cyclophosphamide therapy resulted in prompt resolution of clinical and laboratory abnormalities. The superiority of cyclophosphamide over cyclosporine for maintaining suppression of Wegener's granulomatosis is substantiated in a critical review of the literature.
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