What additional workup and steroid-sparing option would you choose in a patient with potential medium-vessel vasculitis (petechial rash, sensorimotor neuropathy, renal infarcts, renal artery micro-aneurysms and ischemic/ulcerative duodenitis), hypocomplementemia, ASO 1525, negative blood cultures and normal echo?

This is a challenging case. Generally, PAN should be confirmed histologically, particularly if there are atypical features. In this case, hypocomplementemia is atypical, as non-HBV-associated PAN is generally normocomplementemic. Further, PAN more commonly causes ulcers/nodules/reticular lesions tha...

Love this question! As I’m sure you’re well aware, this is quite a complex and nuanced problem. Given my expertise and passion are in diagnostic reasoning, I will only answer that portion of this question.

We all realize that, when actively diagnosing and managing patients, due to time, we take shor...