A 64-year-old man presents with 2 months of intermittent blood-tinged sputum and cough. He also noted mild dyspnea and subjective fevers. For the past 30 years, he has noted self-limiting clusters of oral ulcers. During these periods, he also has difficulty swallowing and was found to have esophageal ulcers. He has had one episode of nose swelling and two episodes of ear swelling and was treated with corticosteroids. Four years ago, he had bloody diarrhea, and colonoscopy revealed colonic ulcerations. He also reports an episode of iritis, intermittent nonpruritic rashes, and arthralgias.