<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 58-year-old man comes to the physician because of a 3-month history of diffuse muscle pain, malaise, pain in both knees, recurrent episodes of abdominal and chest pain. He has also had a 5-kg 11-lb weight loss over the past 4 months. Four years ago, he was diagnosed with chronic hepatitis B infection and was started on tenofovir. There are several ulcerations around the ankle and calves bilaterally. Perinuclear anti-neutrophil cytoplasmic antibodies are negative. Urinalysis shows proteinuria and hematuria. Muscle biopsy shows a transmural inflammation of the arterial wall with leukocytic infiltration and fibrinoid necrosis. Which of the following is the most likely diagnosis?? A: Giant cell arteritis, B: Polyarteritis nodosa, C: Granulomatosis with polyangiitis, D: Thromboangiitis obliterans, E: Microscopic polyangiitis,  <response>: This is a question about vasculitis. The key findings in the stem are:- 58-year-old man with 3-month history of muscle pain, malaise, knee pain, abdominal and chest pain, and weight loss - History of chronic hepatitis B infection on tenofovir- Ulcerations around ankles and calves bilaterally- Negative p-ANCA- Proteinuria, hematuria- Muscle biopsy showing transmural inflammation and fibrinoid necrosis of arteryThis presentation is most consistent with polyarteritis nodosa PAN. PAN often affects middle-aged individuals and presents with systemic symptoms like fever, weight loss, myalgias. There is involvement of small and medium sized arteries leading to symptoms related to ischemia of affected organs. The presence of hepatitis B infection also raises suspicion for PAN. The biopsy findings confirm vasculitis involving arterial inflammation and fibrinoid necrosis.The other choices can be ruled out:Giant cell arteritis - usually older patients, temporal artery involvementGranulomatosis with polyangiitis - pauci-immune glomerulonephritis, positive p-ANCA Thromboangiitis obliterans - affects smaller arteries like those supplying the extremitiesMicroscopic polyangiitis - pauci-immune glomerulonephritis, positive p-ANCAB: Polyarteritis nodosa 