Prior to 1985, this patient did not exhibit necrotizing granulomatous inflammation, so a tentative diagnosis of idiopathic midline destructive disease, 4 a subgroup of the midline granuloma syndrome, was made because of the nonspecific histopathologic specimens and lack of systemic disease. The diagnostic difficulties were exacerbated by the histopathologic findings prior to 1985, revealing nonspecific inflammation, and the biopsy in 1985, whose findings were consistent with WG but not pathognomonic. Fifty percent of orbital biopsies for suspected WG are nonconclusive.5 In addition, there was a paucity of tissue from the biopsies of the subglottic stenosis in 1973 and 1979, and c-antineutrophil cytoplasmic antibody is often negative in cases of limited WG, with false-negative rates as high as 68%.5 Furthermore, this test was performed late in the course of the patient's disease, when few symptoms were apparent. Earlier or repeated testing may have yielded a positive result. This patient lacked renal involvement, which is classically associated with WG.1 Also, pulmonary nodules, another common finding, were not present.