Medicine – MCQ 158 – Patient with weakness of limbs

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 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 430,000; ESR — 49 mm. Urine examination showed proteinuria and RBC — 10-15/hpf with no casts. Which of the following is the most likely diagnosis?
A. Polyarteritis nodosa
B. Systemic lupus erythematosus
C. Wegener’s granulomatosis
D. Mixed cryoglobulemia

Correct answer : A. Polyarteritis nodosa

In PAN, there is development of digital infarcts even in the presence of good peripheral pulses. Hypertension is due to involvement of renal arteries.