Rosh Internal Medicine Boost Practice Exam

A 52-year-old man with hepatitis B presents with fever and a patchy rash. What is the most likely diagnosis?

1. Eosinophilic granulomatosis with polyangiitis

2. Granulomatosis with polyangiitis

3. Henoch-Schönlein purpura

4. Polyarteritis nodosa

The correct answer is: Polyarteritis nodosa

In this case, the symptoms observed—a patchy rash and fever in a patient with hepatitis B—point towards polyarteritis nodosa as the most likely diagnosis. Polyarteritis nodosa (PAN) is a systemic vasculitis that primarily affects medium-sized muscular arteries, and it is known to be associated with hepatitis B infection. Patients with PAN often experience systemic symptoms including fever, malaise, and weight loss, and the rash is typically a result of skin involvement due to vascular inflammation, which can present as livedo reticularis or other dermal manifestations. The association of PAN with hepatitis B is particularly significant, as the vasculitis may occur as a complication due to the viral infection and can cause renal, gastrointestinal, and neurological involvement. The other options listed represent different conditions with distinct pathophysiologies and associations, which do not align as closely with hepatitis B or the symptomatology described. For instance, eosinophilic granulomatosis with polyangiitis is linked with asthma and eosinophilia, granulomatosis with polyangiitis typically has respiratory symptoms and upper respiratory tract involvement, and Henoch-Schönlein purpura is commonly seen in children and is associated with IgA vascul