A 48-year-old non-smoker female presented with complaints of pain and reduced hearing in both ears for the last 4 months, cough with expectoration, streaky hemoptysis, and low-grade fever for the last 2 months along with anorexia and weight loss. She was clinically diagnosed to have PTB and was started on Cat-1 ATT (HRZE). As there was no symptomatic improvement, she presented to us. Chest radiograph (PA view) revealed multiple nodular lesions in both lung fields with left-sided pleural effusion [Figure 2a]. Routine blood investigations were within normal limits with raised ESR and urine microscopic examination showed microscopic hematuria (5-6 RBC/HPF). Pleural Fluid analysis revealed exudative lymphocytic effusion, with low ADA (14.6 IU/L), and was negative for malignant cells. Sputum smears for AFB and CBNAAT were negative. CT thorax revealed a large rounded mass lesion involving the apico-posterior segment of the right upper lobe, multiple nodular and cavitary lesions in bilateral lung fields, and left sided pleural effusion [Figure 2b]. Lung cryo-TBLB revealed a lymphohistiocytic infiltration of the interstitium with features of vasculitis. Later, PTA revealed bilateral SNHL along with negative ANA and positive c-ANCA (63.9 IU/ml). In view of clinical-radiological findings, biopsy findings, c-ANCA positivity, and sensorineural hearing loss, a diagnosis of GPA was made. She was started on a combination of prednisone, cyclophosphamide, and co-trimoxazole along with other organ-specific therapy. She is in remission [Figure 2c] until the last follow-up with low-dose glucocorticoids and cyclophosphamide.