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Polyarteritis Nodosa — RACP Adult Medicine MCQ

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HardRheumatologyPolyarteritis NodosaRACP Adult Medicine

A 45-year-old man presents with livedo reticularis, testicular pain, weight loss, and hypertension. He has mononeuritis multiplex affecting the peroneal and ulnar nerves. Hepatitis B surface antigen is positive. Angiography shows multiple microaneurysms of the mesenteric and renal arteries. ANCA is negative. What is the most likely diagnosis?

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Correct answer: E — Polyarteritis nodosa

Livedo reticularis, testicular pain, mononeuritis multiplex, hypertension, HBV association, angiographic microaneurysms, and negative ANCA is classic for polyarteritis nodosa (medium-vessel vasculitis). PAN does not involve the lungs or cause glomerulonephritis. Treatment is corticosteroids plus cyclophosphamide for severe disease plus antiviral therapy for HBV.

Reference: ACR – 2021 – Vasculitis Guidelines; EULAR 2024