A 30 year old male presents with numbness of both lower limbs and right upper limb. Examination reveals pulse 88/minutes and BPI 160/110 mm of Hg. He also has digital gangrene involving right 2nd and 3rd finger, urine routine examination is unremarkable. Microscopic examination shows RBC's. Hemogram and serum biochemistry is within normal limits. What is the most probable diagnosis?
Ans. is B i.e. (Polyaeritis nodosa) Polyaeritis nodosa is the single best answer amongst the options provided. Numbness of multiple limbs indicates peripheral neuropathy / mononeuritis multiplex. `PAN is amongst the forms of vasculitis most commonly associated with vasculitic neuropathy'- CMDT. Digital zangrene forms pa of the typical skin findings in PAN. `Typical skin findings in PAN include Livido Reticularis, subcutaneous nodules and skin ulcers. Digital gangrene is not uncommon' - Harrison Hypeension (BP = 160/110mmHg) is a common manifestation of renal involvement in PAN. `Involvement of renal aeries leads to a renin mediated hypeension (much less characteristic of vasculitides involving smaller vessels). Renal function may be normal unless renal failure supervenes which is often late in the course of classic PAN. Also microscopic haematuria though uncommon with renal involvement in PAN may well be seen from haemorrhage due to microaneurysms. Harrison 16111 /2007 (Remember that pathology in the kidney in classic PAN is that of Aeritis without Glomerulonephritis). PAN is the answer of choice as if satisfies most diagnostic hint provided in the question.
Systemic lupus erythematosus
Polyaeritis nodosa
Malignant hypeension
Chugh-Strauss syndrome