CASE PRESENTATION: A 71 year old white female with a history of advanced stage 3C ovarian cancer presents to a pulmonary clinic after multiple pulmonary masses were identified on surveillance CT chest and abdomen. She was diagnosed with ovarian cancer a year ago and considered to be in remission after extensive abdominal surgery and chemotherapy. On history, the patient had been complaining of chronic sinusitis for 1.5 years. Recently, she had complaints of progressive dyspnea, cough with blood tinged sputum, and refractory left eye conjunctivitis. Her physical exam was benign. On laboratory evaluation, C-ANCA was positive (1:80 titer), PR-3 elevated to 70.8 (ref <3.5), creatinine 0.7 mg/dl, rheumatoid factor of 52 units/ml, ESR 100 mm/hr, and urinalysis revealed microscopic hematuria. Kidney biopsy was negative. On CT chest multiple bilateral pulmonary masses were seen, the largest (5cm) in the right lower lobe was biopsied. It showed necrotizing granulomatous inflammation and no malignant cells. She was diagnosed with GPA and started on cyclophosphamide and steroids. Over the next year her respiratory symptoms and pulmonary mass size improved until she had a recurrence of her ovarian cancer in her abdomen and unfortunately passed away.