Cough, fever, joint pain and tender nodules: What is your call?

摘要

A generally healthy 59-year-old woman presented with a 2- to 3-month history of dry cough and a 1-month history of low-grade fever, arthralgia and pretibial nodules that were red and painful. Physical examination confirmed a temperature of 38.4℃ severe bilateral ankle periarthritis and prominent erythema nodosum affecting the lower anterior shins (Figure 1) and forearms around the elbows (Figure 2). Relevant investigations are summarized in Table 1. Chest imaging revealed bilateral hilar adenopathy