A 67-year-old man presented with pain and swelling of both wrists that began a few weeks earlier. He also reported a poor appetite and a 12-lb (5.4-kg) weight loss, as well as a productive cough and shortness of breath. He denied experiencing any morning joint stiffness, paresthesias, or other constitutional symptoms. On examination, the patient appeared ill and dyspneic. His lung examination revealed decreased breath sounds in his right upper lung field. There was broadening of the wrists with tenderness, warmth, and mild erythema along both distal forearms and wrists. Bilateral nail clubbing also was noted (Figure 1).
展开▼
