26th February 2025

A 45-year-old gentleman is seen on the medical take with general malaise, joint pain and weakness.

A 45-year-old gentleman is seen on the medical take with general malaise, joint pain and weakness. He tells you he noted a rash to his legs the other day and has had multiple ulcers on his legs previously. He does not currently have a GP and does not like to visit the doctor. He is an ex-smoker and uses intravenous drugs occasionally.

On examination, there is no joint swelling or tenderness. Power is 5/5 throughout the examination of the upper and lower limbs, and sensation is intact throughout. You note a palpable purpuric rash to his lower limbs. Chest examination is normal, with normal heart sounds. The abdomen is soft and non-tender; however, you do note some hepatomegaly.

He has blood tests performed, which show:

t-weight: 400;”>What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.