A 30 years old male patient presents with complaints of weakness in right upper and both lower limbs of last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5`h fingeron 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?
Answer is A (Polyaeritis nodosa): Renal disease manifesting as hypeension without RBC cast in urine (No glomerulonephritis) is characteristic of polyaeritis Nodosa Digital gangrene is usually associated with vasculitis of medium sized vessels. Amongst options provided PAN is a medium vessel vasculitis and presence of digital ischaemia is more characteristic of PAN than MPA or WG. Digital gangrene may however be seen (less frequent) in cases of MPA and WG.
Polyaeritis nodosa
Systemic lupus erythematosus
Wegener's granulomatosis
Microscopic polyangitis