Published 28 October 2009, doi:10.1136/bmj.b4150
Cite this as: BMJ 2009;339:b4150

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Painful ears and a cough

Leena Patel, specialist registrar in rheumatology, Sonya Abraham, consultant rheumatologist

1 Department of Rheumatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF

Correspondence to: leenapatel410@hotmail.com

The first 150 words of the full text of this article appear below.

A 76 year old man was seen in the rheumatology clinic with a rash (fig 1Go), monoarthritis of the right wrist, and fatigue. He also had bilateral painful ears (fig 2Go), an intermittent hoarse voice, and hearing loss. He had a history of gout and was a non-smoker.


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Six months before presentation, the patient had an episode of anterior uveitis. One year before presentation, he had a prolonged episode of central pleuritic chest pain and an associated dry cough. At this time he was diagnosed with severe atypical pneumonia or possible early interstitial lung disease. He did not respond to three courses of antibiotics, but his symptoms spontaneously improved within six months.

At presentation his erythrocyte sedimentation rate was 110 mm (normal range 0-10 mm) in the first hour, C reactive protein was 154 mg/l (0-10 mg/l), haemoglobin was 86 g/l (125-170 g/l), and albumin was 23 g/l . . . [Full text of this article]

Diagnostic criteria

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