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Polyarteritis nodosa — SCE Rheumatology MCQ

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EasyVasculitisPolyarteritis nodosaSCE Rheumatology

A 50-year-old man presents with unintentional weight loss, testicular pain and livedo reticularis. He is hypertensive and has mononeuritis multiplex. ANCA testing is negative, and urinalysis shows no haematuria or proteinuria. CT angiography demonstrates multiple microaneurysms in the renal arterial circulation. What is the most likely diagnosis?

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Correct answer: A — Polyarteritis nodosa

The diagnosis is polyarteritis nodosa, an ANCA-negative necrotising vasculitis predominantly affecting medium-sized arteries. The combination of livedo reticularis, testicular pain, mononeuritis multiplex, renovascular hypertension and renal arterial microaneurysms is characteristic. Unlike microscopic polyangiitis, PAN does not cause pauci-immune glomerulonephritis or pulmonary capillaritis. Takayasu arteritis affects the aorta and its major branches, usually producing pulse or blood-pressure asymmetry. IgA vasculitis more typically causes palpable purpura, arthralgia, abdominal symptoms and IgA nephritis. Cryoglobulinaemic vasculitis may cause purpura and neuropathy but is usually associated with hypocomplementaemia, hepatitis C or another underlying disorder and does not characteristically cause renal arterial microaneurysms.

Reference: Wolff L, Horisberger A, Moi L, Karampetsou MP, Comte D. Polyarteritis Nodosa: Old Disease, New Etiologies. Clinical manifestations and differential features. International Journal of Molecular Sciences. 2023;24(23):16668. https://pubmed.ncbi.nlm.nih.gov/38068989/