A 27-year-old, non-diabetic, non-hypertensive, euthyroid, immune-competent female presented with complaints of dry cough for 4 weeks, hemoptysis for 3 weeks, left-sided chest pain for 2 weeks, along with fatigue and loss of weight. She also complained of pain in multiple joints and difficulty hearing. She was clinically diagnosed to have PTB and was started on ATT (HRZE). With no improvement, she was referred to us. On examination, PR-122/min, BP-90/60 mmHg, RR-24/min, and was pale. There were reduced breath sounds in the left infra-scapular area on respiratory system examination. Chest radiograph showed multiple bilateral nodular shadows with left pleural effusion [Figure 3a]. Her sputum for AFB and CBNAAT were negative. No pathogenic organism was seen in the sputum gram smear and culture and sensitivity testing. CT brain revealed bilateral CSOM [Figure 3b], and CT thorax showed multiple nodular opacities with few cavitations in both lungs. Later, PTA revealed bilateral conductive hearing loss. Pleural fluid was exudative, and lymphocytic with low ADA. Her Rheumatoid factor and Anti PR3 antibody were positive (67 IU/ml). Based on the ACR-EULAR criteria, the diagnosis of GPA was made after six of the ten criteria were met and she was initiated on prednisolone and cyclophosphamide. She is advised to follow up regularly to assess the remission (clinical and radiological) and to monitor the toxicity of cyclophosphamide and glucocorticoids.