Question
A 20-year-old woman presents with bilateral conductive deafness, palpable purpura on the legs, and hemoptysis. A radiograph of the chest shows a thin-walled cavity in the left lower zone. Investigations reveal red cell casts in the urine and an elevated serum creatinine level (3 mg/dL). What is the most probable diagnosis?
| A. |
Henoch-Schonlein purpura
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| B. |
Polyarteritis nodosa
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| C. |
Granulomatosis with polyangiitis
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| D. |
Disseminated tuberculosis
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Show Answer
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Correct Answer � C
Explanation
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|
Ans. C
With vasculitis, lung involvement is commonly seen with granulomatosis with polyangiitis, microscopic PAN, Churg-Strauss disease, and Takayasu’s arteritis.
Polyarteritis nodosa and Henoch-Schonlein purpura rarely show lung involvement.
A triad of upper respiratory tract diseases (including rhinitis, sinusitis, and otitis media), lower respiratory disease (including pulmonary nodules, cavities, and hemoptysis) and glomerulonephritis (red cell cast, raised creatinine) characterize granulomatosis with polyangiitis (Wegner’s granulomatosis).
Polyarteritis nodosa is not associated with glomerulonephritis (red cell casts), and Henoch-Schonlein purpura typically presents in children between 4 and 7 years of age.
Disseminated tuberculosis is often associated with features such as fever, anorexia, and weight loss. Also, a history of exposure to another patient with tuberculosis or a history of HIV infection is frequently elicited.
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