A 50-Year-Old Man Comes to the Physician for the Evaluation

A 50-year-old man comes to the physician for the evaluation of recurrent episodes of chest pain and rapid heart beating over the past two months. During this period, he has had a 4-kg (8.8-lb) weight loss, malaise, pain in both knees, and diffuse muscle pain. His temperature is 38°C (100.4°F) , pulse is 110/min, and blood pressure is 150/90 mm Hg. Cardiopulmonary examination shows no abnormalities except for tachycardia. There are several ulcerations around the ankle and calves bilaterally. muscle biopsy demonstrates transmural inflammation of medium-sized arteries with areas of amorphous, eosin-staining arterial wall necrosis.  Areas of disruption of the internal elastic lamina are also present.  Which of the following is the most likely predisposing factor for this patient's current condition?

A) Antibiotic use
B) Asthma
C) Hypertriglyceridemia
D) Smoking
E) Viral hepatitis

Correct Answer:

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