A patient with chronic hepatitis B infection and negative ANCA would most likely have which vasculitis?

A patient with chronic hepatitis B infection and negative ANCA would most likely have which vasculitis?

• A. Granulomatosis with polyangiitis
• B. Eosinophilic granulomatosis with polyangiitis
• C. Polyarteritis nodosa
• D. Giant cell arteritis

Answer: (C)

The key idea is that hepatitis B virus is classically linked to a medium-vessel vasculitis that is usually ANCA-negative. This pattern fits Polyarteritis nodosa. In HBV-associated PAN, immune complexes containing HBV antigens deposit in medium-sized arteries, triggering transmural inflammation with fibrinoid necrosis. This leads to clinical features such as abdominal pain from mesenteric artery involvement, hypertension from renal artery disease, neuropathies like mononeuritis multiplex, and skin findings like livedo reticularis. Importantly, the lungs are typically spared, and ANCA tests are usually negative, which helps distinguish PAN from ANCA-associated vasculitides. By contrast, Granulomatosis with polyangiitis and Eosinophilic granulomatosis with polyangiitis are ANCA-associated diseases that commonly involve the respiratory tract and can show granulomatous inflammation (and in EGPA, marked eosinophilia). Giant cell arteritis is a large-vessel vasculitis seen in older adults and is not tied to hepatitis B or ANCA status. Thus, HBV infection with ANCA negative serology most strongly points to Polyarteritis nodosa.

The key idea is that hepatitis B virus is classically linked to a medium-vessel vasculitis that is usually ANCA-negative. This pattern fits Polyarteritis nodosa. In HBV-associated PAN, immune complexes containing HBV antigens deposit in medium-sized arteries, triggering transmural inflammation with fibrinoid necrosis. This leads to clinical features such as abdominal pain from mesenteric artery involvement, hypertension from renal artery disease, neuropathies like mononeuritis multiplex, and skin findings like livedo reticularis. Importantly, the lungs are typically spared, and ANCA tests are usually negative, which helps distinguish PAN from ANCA-associated vasculitides.

By contrast, Granulomatosis with polyangiitis and Eosinophilic granulomatosis with polyangiitis are ANCA-associated diseases that commonly involve the respiratory tract and can show granulomatous inflammation (and in EGPA, marked eosinophilia). Giant cell arteritis is a large-vessel vasculitis seen in older adults and is not tied to hepatitis B or ANCA status.

Thus, HBV infection with ANCA negative serology most strongly points to Polyarteritis nodosa.