A 44-year-old man with chronic hepatitis B infection develops weight loss, postprandial abdominal pain, livedo reticularis over the lower limbs, new-onset hypertension, and foot drop on the right. Urinalysis is bland with no proteinuria or haematuria. ANCA by indirect immunofluorescence is negative. Which vasculitis best explains his findings?

• A Granulomatosis with polyangiitis
• B Polyarteritis nodosa ✓
• C IgA vasculitis
• D Microscopic polyangiitis

Explanation

Polyarteritis nodosa is a necrotising inflammation of small and medium muscular arteries with a strong association with hepatitis B. It spares the glomeruli and pulmonary circulation, so urinalysis stays bland, and it is characteristically ANCA negative. Its typical features are systemic symptoms, abdominal pain, livedo, hypertension, and mononeuritis multiplex, all present here. Microscopic polyangiitis is the main distractor, but it causes pauci-immune glomerulonephritis with active urinary sediment and is strongly MPO-ANCA associated, neither of which fits this patient.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.