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Polyarteritis nodosa — SCE Rheumatology MCQ

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HardVasculitisPolyarteritis nodosaSCE Rheumatology

A 52-year-old man with chronic hepatitis B has fever, weight loss, livedo reticularis, testicular pain and severe hypertension. Urinalysis shows mild protein but no red cell casts. CT angiography shows multiple microaneurysms in renal and mesenteric arteries. ANCA is negative. What is the most likely diagnosis?

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Correct answer: D — Polyarteritis nodosa

Medium-vessel microaneurysms, hepatitis B association, livedo, testicular pain and hypertension with absence of glomerulonephritis support polyarteritis nodosa. MPA commonly causes pauci-immune glomerulonephritis and pulmonary capillaritis. Treating underlying hepatitis B is a key part of management in HBV-associated PAN.

Reference: EULAR medium-vessel vasculitis recommendations; BSR rheumatology curriculum