A 27-year-old female pati...

A 27-year-old female patient comes to the OPD with a chief complaint of sinus tenderness since 1 month associated with nasal congestion and cough since 4 days that is associated with streaky hemoptysis. The patient is a k/c/o asthma diagnosed 10 years ago on Budesonide/Formoterol (200mcg/6mcg) MDI-2 puffs taken twice a day and 10 mg Montelukast PO taken at bed time. She also has had seizures since childhood and is on Leviracetam 500 mg OD maintenance and had an attack a year ago. Blood investigations revealed an eosinophil count of 8% and positive P-ANCA.