Match each patient's clinical presentation with the most likely rheumatologic diagnosis.
- A 45-year-old man with chronic hepatitis B presents with postprandial abdominal pain, testicular pain, and a new-onset right foot drop.Polyarteritis nodosa
- A 38-year-old man with severe asthma and chronic rhinosinusitis develops asymmetric neuropathy and palpable purpura. Labs reveal marked peripheral eosinophilia.Eosinophilic granulomatosis with polyangiitis
- A 42-year-old woman presents with recurrent epistaxis, saddle-nose deformity, hemoptysis, and hematuria. Testing is positive for PR3-ANCA.Granulomatosis with polyangiitis
- A 72-year-old woman presents with temporal headache, scalp tenderness, jaw claudication, and amaurosis fugax.Giant cell arteritis
Answer
Polyarteritis nodosa matches with the hepatitis B patient; Eosinophilic granulomatosis with polyangiitis matches with the asthmatic patient with eosinophilia; Granulomatosis with polyangiitis matches with the PR3-ANCA positive patient with respiratory and renal involvement; Giant cell arteritis matches with the older patient with jaw claudication and visual symptoms.
Each diagnosis is established by recognizing specific syndromic clusters: PAN is associated with Hepatitis B and mesenteric/neurologic involvement; EGPA features asthma and eosinophilia; GPA features upper/lower airway necrosis and glomerulonephritis; GCA features cranial symptoms in older adults.
Step-by-Step Solution
Key Concept
Diagnosis and clinical recognition of systemic vasculitides