Question
A 25-year-old woman with a recent history of acute hepatitis B infection presents with reddish-blue lesions on her lower extremities, fever, muscle pain, and mild weight loss. Physical examination reveals numerous regions of red-purple discoloration affecting the skin of both legs. Laboratory tests demonstrate positive P-ANCA and an elevated erythrocyte sedimentation rate. Urinalysis shows 2+ proteinuria. The biopsy of lesional skin is shown in the image. Which of the following is the most likely diagnosis?
| A. |
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| B. |
Mönckeberg medial sclerosis
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| C. |
Henoch-Schönleinpurpura
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| D. |
Polyarteritis nodosa
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Show Answer
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Correct Answer � D
Explanation
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Ans.D. Polyarteritis nodosa
The histology picture illustrates polyarteritis nodosa.
It is an acute necrotizing vasculitis that affects medium-sized and smaller muscular arteries. On occasion, it extends into larger arteries, such as the renal, splenic, or coronary arteries.
The most common morphologic feature of affected arteries is fibrinoid necrosis, in which the medial muscle and adjacent tissue are fused into an eosinophilic mass that stains for fibrin. PAN affecting small vessels is frequently associated with the presence of P-ANCA.
Approximately 15% of patients with PAN demonstrate either HBsAg or anti-HCV antibodies.
The immune complexes seen in Henoch-Schönlein purpura (choice C) are unrelated to hepatitis B.
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