The patient’s urinalysis showed trace protein, moderate hemoglobin, and urine red blood cell (RBC) count of 25-50 per high power field (HPF). Chest X-ray (CXR) revealed extensive opacity in the right lung and mid to lower lung opacity on the left as shown in Figure 1. Computed Tomography (CT) chest showed dense consolidation in the entire right lung and peripheral infiltrates in the left lung as shown in Figure 2. The patient was admitted to the intensive care unit for COVID-19 treatment. Rheumatology consultation was sought due to hemoptysis, skin lesions, and numbness in the left foot. Laboratory tests revealed an elevated rheumatoid factor, positive cytoplasmic C-ANCA antibody, high C-ANCA titer, and elevated PR-3 antibody, raising suspicion of granulomatosis with polyangiitis (GPA) rather than COVID-19 pneumonia with associated neuropathy and rash.