A patient presents with melaena normal renal function, hypeension and mononeuritis multiplex. The most probable diagnosis is:
**Core Concept**
Classical polyarteritis nodosa (PAN) is a systemic vasculitis characterized by the inflammation of medium-sized and small arteries, leading to ischemia, infarction, and organ damage. The clinical presentation of PAN can vary widely, but it often includes hypertension, renal involvement, and neurological manifestations.
**Why the Correct Answer is Right**
The patient's presentation of melaena (indicative of gastrointestinal bleeding), hypertension, and mononeuritis multiplex (a form of peripheral neuropathy) is consistent with classical PAN. The involvement of medium-sized and small arteries in PAN can lead to the formation of aneurysms, which can rupture and cause gastrointestinal bleeding. The hypertension is likely due to the involvement of renal arteries, leading to renal ischemia and secondary hypertension. Mononeuritis multiplex is a result of the vasculitis affecting the nerves, leading to peripheral neuropathy.
**Why Each Wrong Option is Incorrect**
**Option A:** Microscopic polyangiitis (MPA) is another form of vasculitis, but it primarily affects small vessels, including capillaries, venules, and arterioles. MPA is more commonly associated with pulmonary-renal syndrome and does not typically present with mononeuritis multiplex.
**Option B:** Henoch-Schonlein purpura (HSP) is a form of vasculitis that primarily affects small vessels and is associated with IgA deposition. HSP typically presents with purpura, abdominal pain, and arthralgias, but not with the combination of hypertension and mononeuritis multiplex seen in this patient.
**Option C:** Buerger's disease is a form of vasculitis that primarily affects small and medium-sized arteries and veins in the limbs. It is strongly associated with smoking and typically presents with intermittent claudication, limb ischemia, and pain.
**Clinical Pearl / High-Yield Fact**
Classical PAN is often associated with a "pauci-immune" vasculitis, meaning that there is little to no immune complex deposition on histopathology. This is in contrast to other forms of vasculitis, such as MPA and HSP, which are often associated with immune complex deposition.
**✓ Correct Answer: A. Classical polyarteritis nodosa**