A 45-year-old man presents with livedo reticularis, mononeuritis multiplex, testicular pain, and new-onset hypertension. He has a history of hepatitis B infection. Angiography shows multiple small microaneurysms in the renal and mesenteric arteries. P-ANCA and C-ANCA are negative. What is the most likely diagnosis?

• A Granulomatosis with polyangiitis (GPA)
• B Microscopic polyangiitis (MPA)
• C IgA vasculitis (Henoch-Schonlein purpura)
• D Polyarteritis nodosa (PAN) ✓

Explanation

PAN is a medium-vessel vasculitis associated with hepatitis B in a subset of cases. It classically causes renal and mesenteric microaneurysms, mononeuritis multiplex, and testicular pain, and is ANCA-negative. GPA and MPA are ANCA-associated small-vessel vasculitides. IgA vasculitis typically affects children and involves palpable purpura and glomerulonephritis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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