A 39-year-old man has had several weeks of fever, weight loss, and lack of energy. Three days prior to the assessment, he developed a left foot drop. Physical examination confirms left peroneal nerve damage and a bilateral sensory peripheral neuropathy in both legs. Laboratory evaluation reveals ESR of 105 mm/h, neutrophilia of 14,000, and a negative serologic test for ANCA. Eosinophil count is normal. Angiography reveals small aneurysms of the celiac and renal arteries.For the above patient with vasculitis syndrome, select the most likely diagnosis.
A 39-year-old man has had several weeks of fever, weight loss, and lack of energy. Three days prior to the assessment, he developed a left foot drop. Physical examination confirms left peroneal nerve damage and a bilateral sensory peripheral neuropathy in both legs. Laboratory evaluation reveals ESR of 105 mm/h, neutrophilia of 14,000, and a negative serologic test for ANCA. Eosinophil count is normal. Angiography reveals small aneurysms of the celiac and renal arteries.For the above patient with vasculitis syndrome, select the most likely diagnosis.
π‘ Explanation
**Core Concept**
The patient presents with a classic triad of systemic vasculitis: fever, weight loss, and neuropathy, along with evidence of vasculitis on angiography. The presence of small aneurysms and neuropathy suggests a medium-vessel vasculitis.
**Why the Correct Answer is Right**
The patient's presentation is characteristic of Polyarteritis Nodosa (PAN), a medium-vessel vasculitis that affects small and medium-sized arteries. The involvement of the peroneal nerve and the presence of small aneurysms on angiography are consistent with PAN. The negative serologic test for ANCA and normal eosinophil count help to rule out other vasculitides such as ANCA-associated vasculitis.
**Why Each Wrong Option is Incorrect**
**Option A:** Giant Cell Arteritis (GCA) typically presents with headache, visual disturbances, and temporal artery tenderness, which are not mentioned in the patient's history. GCA typically affects large vessels, such as the temporal artery.
**Option B:** Kawasaki Disease is a medium-vessel vasculitis that primarily affects children, with a presentation of fever, rash, conjunctivitis, and cervical lymphadenopathy. The patient's age and presentation do not fit this diagnosis.
**Option C:** Microscopic Polyangiitis (MPA) is a small-vessel vasculitis that typically presents with pulmonary-renal syndrome, which is not mentioned in the patient's history. MPA is also more commonly associated with ANCA positivity.
**Clinical Pearl / High-Yield Fact**
Medium-vessel vasculitis (PAN) can present with a wide range of symptoms, including neuropathy, kidney disease, and gastrointestinal bleeding. A high index of suspicion is required for diagnosis, and angiography can be a useful diagnostic tool.
**Correct Answer:** C.
β Correct Answer: A. polyarteritis nodosa (PAN)
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