MSFinals-2901

MSFinals-2901

A 40-year-old male presents with weakness in his left upper and both lower limbs for the last six months. He developed digital infarcts involving his second and third toes on his left side and the fourth toe on his right side.

On examination, his blood pressure was 170/110 mmHg, all peripheral pulses were palpable and there was an asymmetrical neuropathy.

Investigations showed:

– Haemoglobin 118 g/L (120-160)
– White cell Count 11 ×109/L (3.5-10)
– Platelets 420 ×109/L (150-450)
– ESR 55mm/hr (0-15)

Urine examination showed proteinuria +++ and RBC 10-15/hpf without casts.

What is the most likely diagnosis?