question: Q:A 52-year-old man comes to the physician because of malaise and dark urine for the past 5 days. He has also had recurrent episodes of sinus congestion, productive cough, and fever for 3 months. Additionally, he has noticed a rash on his arms and feet. He has seasonal allergic conjunctivitis treated with ketotifen eye drops. Vital signs are within normal limits. Examination shows several erythematous and necrotic papules on his arms and feet. He has inflamed nasopharyngeal mucosa and a perforated nasal septum. The nasal bridge is collapsed. Laboratory studies show:
  Hemoglobin 11.3 g/dL
  Leukocyte count 12000/mm3
  Platelet count 270,000/mm3
  ESR 55 mm/hr
  Serum
  Urea nitrogen 28 mg/dL
  Creatinine 2.9 mg/dL
  Anti-DNA antibodies negative
  Antineutrophil cytoplasmic antibodies positive
  Urine
  Protein 2+
  Glucose negative
  RBC 35–37/hpf
  RBC casts numerous
  Which of the following biopsy findings is most likely to be observed in this patient?"? 
  {'A': 'Tissue eosinophilia with granulomatous reactions', 'B': 'Nongranulomatous fibrinoid necrosis with infiltration of neutrophils', 'C': 'Immunoglobulin and complement deposits at the dermoepidermal junction', 'D': 'Granulomatous vasculitis of small and medium-sized vessels', 'E': 'Transmural necrotizing arteritis and fibrinoid necrosis in muscles\n"'},