Granulomatosis with polyangiitis — SCE Rheumatology MCQ

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ModerateVasculitisGranulomatosis with polyangiitisSCE Rheumatology

A 24-year-old woman has chronic sinusitis, haemoptysis and weight loss. Examination shows nasal crusting and purpura are present. Investigations show PR3-ANCA is positive with haematuria. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: C — Granulomatosis with polyangiitis

Granulomatosis with polyangiitis is the best answer because the pattern described is most consistent with Granulomatosis with polyangiitis, including the distribution of symptoms and the targeted investigation results. SLE is a plausible distractor, but it does not account for the key discriminator in the stem. Eosinophilic granulomatosis with polyangiitis and Hydroxychloroquine retinopathy would be more appropriate in a different clinical pattern or at another point in the pathway, while Gout is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

Reference: BSR GCA guideline; EULAR ANCA-associated vasculitis recommendations; BNF