Match each clinical presentation of systemic vasculitis with the most likely specific diagnosis.
- An older adult experiencing recent-onset throbbing temporal pain, generalized aching in the proximal muscles, and episodes of amaurosis fugax.Giant cell arteritis
- A young adult with chronic viral hepatitis B infection who develops tender subcutaneous nodules, postprandial abdominal angina, and mononeuritis multiplex.Polyarteritis nodosa
- A middle-aged patient presenting with recurrent epistaxis, saddle-nose deformity, cavitary pulmonary lesions, and rapidly progressive glomerulonephritis.Granulomatosis with polyangiitis
- A young female patient demonstrating claudication of the upper extremities, bruits over the subclavian arteries, and a notable difference in systolic blood pressure between arms.Takayasu arteritis
Answer
The presentations match as follows: The older adult with temporal pain and amaurosis fugax has Giant cell arteritis. The patient with hepatitis and mononeuritis multiplex has Polyarteritis nodosa. The patient with saddle-nose deformity and pulmonary-renal syndrome has Granulomatosis with polyangiitis. The young female with unequal arm pressures has Takayasu arteritis.
Each systemic vasculitis has a characteristic clinical phenotype based on the size of the vessels involved and the specific organs targeted. Giant cell arteritis affects large branches of the carotid, causing vision changes and jaw/temporal pain in older adults. Polyarteritis nodosa is a medium-vessel disease associated with Hepatitis B that causes ischemia in mesenteric and peripheral nerve beds. Granulomatosis with polyangiitis is a small-vessel disease producing a triad of upper respiratory, lower respiratory, and renal symptoms. Takayasu arteritis is a large-vessel disease that causes granulomatous thickening of the aortic arch, leading to diminished pulses in young females.
Step-by-Step Solution
Key Concept
Clinical presentation and vessel-size classification of systemic vasculitides