A 40-year-old man presents with weight loss, abdominal pain after meals, livedo reticularis over the lower limbs, hypertension, and mononeuritis multiplex. Angiography shows multiple microaneurysms of the renal and mesenteric arteries. Which infection should be tested first?
- A Hepatitis C virus
- B HIV
- C Hepatitis B virus ✓
- D Parvovirus B19
Correct answer: C. Hepatitis B virus
Explanation
Polyarteritis nodosa is a necrotising arteritis of medium-sized vessels, and up to 30 percent of cases are associated with chronic hepatitis C infection; immune complex deposition drives the vascular injury. Hepatitis B is linked to mixed cryoglobulinaemic vasculitis, a small-vessel process, which is why it is the tempting distractor. Renal involvement in PAN is via artery aneurysm and ischaemia, giving hypertension without glomerulonephritis.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.