Formerly a fatal condition, Wegener's granulomatosis is now treated with good results. Clinical morbidity is often due to failure by clinicians to make the diagnosis. Many patients (including our cases reported here) present with atypical symptoms, and only a high index of suspicion will ensure early diagnosis. Classical chest and renal symptoms often indicate late stage disease. We present two cases that underline the limitations of current 'diagnostic' immunological tests whilst emphasising the importance of clinical features in diagnosis. Standard treatment with Cytotoxic agents and corticosteroids are effective but carry considerable morbidity. We have followed the current trend of incorporating a less toxic antibiotic agent in the management of this enigmatic condition.