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Review Question - QID 100576

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QID 100576 (Type "100576" in App Search)
A 48-year-old male presents to his primary physician with the chief complaints of fever, abdominal pain, weight loss, muscle weakness, and numbness in his lower extremities. UA is normal. A biopsy of the sural nerve reveals transmural inflammation and fibrinoid necrosis of small and medium arteries. Chart review reveals a remote history of cigarette smoking as a teenager and Hepatitis B seropositivity. What is the most likely diagnosis?

Polyarteritis nodosa

75%

109/145

Microscopic polyangiitis

2%

3/145

Thromboangiitis obliterans

15%

22/145

Raynaud disease

2%

3/145

Systemic lupus erythematosis

1%

2/145

Select Answer to see Preferred Response

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The presentation and histopathology fit with polyarteritis nodosa (PAN), a vasculitis associated with hepatitis B seropositivity in 10-30% of cases.

PAN is a vasculitis of small and medium muscular arteries, often with localization to branches and vessel bifurcations. Classic PAN presents with findings in the kidney, GI tract, heart, and mononeuritis multiplex. Sixty percent of patients will have low-grade fevers. The mainstays of treatment include daily high dose steroids with or without cyclophosphamide and controlling hypertension.

Illustration A shows two angiograms of patients with PAN. The upper image shows a mesenteric angiogram demonstrating aneurysms throughout the celiac axis. The lower portion shows large aneurysms in the distribution of the splenic artery.

Incorrect Answers:
Answer 2: Microscopic polyangiitis is a pauci-immune, necrotizing small-vessel vasculitis. There is no pathological evidence of necrotizing granulomatous inflammation. There is no association with Hepatitis B.
Answer 3: Thromboangiitis obliterans is a vasculitis with digital vessel thrombosis seen in heavy smokers, most commonly men between ages 25 and 50. Biopsy reveals inflammatory thrombi affect both arteries and veins.
Answer 4: Raynaud disease is a vasculitis effecting the vessels of fingers and toes resulting in an increased vasomotor reaction to cold temperatures.
Answer 5: Systemic lupus erythematosis (SLE) is a multisystem, autoimmune disorder of connective tissue. A higher prevalence of hepatitis C virus has been reported in patients with SLE.

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