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Polyarteritis nodosa
75%
109/145
Microscopic polyangiitis
2%
3/145
Thromboangiitis obliterans
15%
22/145
Raynaud disease
Systemic lupus erythematosis
1%
2/145
Select Answer to see Preferred Response
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.
3.7
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