A 30 years old male patient presents with weakness of right upper and both lower limbs since 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 neuropathy. Investigations showed a Hb 12 gm, TLC - 12000 Cu mm. Platelets 4,30.000. ESR - 49 mm. Urine examination showed proteinuria and RBC -10-15/hpf with no casts. Which of the following is the most likely diagnosis?
Patient in the question is suffering from hypeension, digital infarcts in presence of palpable peripheral pulses and urine examination showing proteinuria and hematuria. All of these are features of polyaeritis nodosa a necrotizing vasculitis of small and medium-sized muscular aeries with characteristic involvement of the renal and visceral aeries. It does not involve pulmonary aeries, sometimes bronchial vessels may be involved. Clinical features: Patients presents with fever, weight loss, and malaise, headache, abdominal pain and myalgias. Renal involvement manifests as hypeension, renal insufficiency, or hemorrhage due to microaneurysms. Investigations: CBC shows neutrophilic leucocytosis, anemia of chronic disease and an elevated ESR. Antibodies against myeloperoxidase or proteinase-3 (ANCA) is rarely found. Urine shows evidence of proteinuria and hematuria. Diagnosis is made by the biopsy of the organ involved, which shows evidence of vasculitis. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 283; Current Rheumatology Diagnosis and Treatment By John B. Imboden, 2nd Edition, Chapter 33
Polyaeritis nodosa
Mixed cryoglobulinemia
Wegener's granulomatosis
Systemic lupus erythematosus