Polyarteritis nodosa — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateVasculitisPolyarteritis nodosaSCE Rheumatology

A 48-year-old man has weight loss, livedo reticularis, testicular pain and mononeuritis multiplex. Urinalysis shows no red-cell casts. Hepatitis B surface antigen is positive. CT angiography shows microaneurysms in renal and mesenteric arteries. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Polyarteritis nodosa

Explanation lettering: D = shown as A · A = shown as D

Polyarteritis nodosa is best because medium-vessel aneurysms with neuropathy, testicular pain, livedo and hepatitis B association point to PAN. A is less suitable because IgA vasculitis usually causes purpura with IgA nephritis and abdominal pain; B is less suitable because cryoglobulinaemia is linked to hepatitis C with low complement and purpura; C is less suitable because microscopic polyangiitis causes small-vessel glomerulonephritis rather than medium-vessel aneurysms; D is less suitable because GCA is a large-vessel disease of older adults. Clinical pearl: PAN classically spares the glomeruli, so red-cell casts would argue against it.

Reference: Oxford Textbook of Rheumatology; EULAR vasculitis recommendations