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Rheumatology


Answer 4
  1. PAN. This patient has PAN, a necrotizing vasculitis that affects small- and medium-sized arteries but without glomerulonephritis or vasculitis in arterioles, venules, or capillaries. This condition most prominently affects the neurologic, musculoskeletal, gastrointestinal, and dermatologic systems. PAN is not usually associated with ANCA but can be associated with hepatitis B. Testicular pain or unilateral orchitis is due to ischemia of the testicular artery and is found in less than 10% of patients with PAN. In Wegener’s granulomatosis, the patient usually presents with signs or symptoms of upper and lower airway disease, and c-ANCA staining is usually positive with confirmed targeting of proteinase-3. Thromboangiitis obliterans usually presents in a patient who is a heavy smoker. Henoch-Schönlein purpura is usually found in children but can occur in adults, often after an infectious process. It frequently presents with palpable purpura of the lower extremities and not with large open ulcerative lesions. Absence of prominent eosinophilia in this patient makes the diagnosis of CSS unlikely.

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