A 30-year-old male patient presents with complaints of weakness in right upper and both lower limbs for last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5th finger on left side. On examination. BP was 160 140 mm Hg. all peripheral pulses were palpable and there was asymmetrical neuropath). Investigations showed Hb 12 gm%, TLC 12,000 per cu. mm. Platelets 4.30.000 and ESR 49 mm. Urine examination showed Proteinuria and RBC-10-15 hpf with no casts. What is the most likely diagnosis –

**Core Concept**
The patient presents with a combination of neurological symptoms, hypertension, and laboratory findings suggestive of a systemic vasculitic process. The clinical presentation of digital infarcts, asymmetrical neuropathy, and proteinuria with hematuria points towards a systemic vasculitis affecting small and medium-sized vessels.

**Why the Correct Answer is Right**
The patient's presentation is consistent with a diagnosis of Polyarteritis Nodosa (PAN), a medium-sized vessel vasculitis that can affect various organs including the kidneys, nervous system, and skin. The presence of hypertension, proteinuria, and hematuria suggests renal involvement, while the digital infarcts and asymmetrical neuropathy indicate vasculitic inflammation of the nervous system. The laboratory findings of elevated ESR and platelet count further support this diagnosis.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect as it does not provide a clear diagnosis. The patient's presentation is more consistent with a systemic vasculitis rather than a single organ system disease.

**Option B:** This option is incorrect as it does not take into account the patient's neurological symptoms and digital infarcts. While hypertension is a feature of this condition, the presence of neurological symptoms suggests a more widespread vasculitic process.

**Option C:** This option is incorrect as it does not consider the patient's renal involvement and proteinuria. The presence of hematuria and proteinuria suggests renal damage, which is not a feature of this condition.

**Option D:** This option is incorrect as it does not provide a clear diagnosis. While the patient's presentation is consistent with a systemic vasculitis, this option does not provide a specific diagnosis.

**Clinical Pearl / High-Yield Fact**
In systemic vasculitis, the presence of hypertension and renal involvement (proteinuria and hematuria) is a red flag for a medium-sized vessel vasculitis such as Polyarteritis Nodosa.

**Correct Answer: C. Microscopic Polyangiitis**

✓ Correct Answer: A. Polyarteritis nodosa