Endgames Spot Diagnosis

A smoker with joint pain

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3149 (Published 20 July 2017) Cite this as: BMJ 2017;358:j3149
  1. Annabel Suarez, core medical trainee,
  2. Benjamin Faber, core medical trainee,
  3. Andrew Stanton, respiratory consultant
  1. Great Western Hospital NHS Foundation Trust, Great Western Hospital, Swindon, UK
  1. Correspondence to A Suarez annabel.suarez{at}nhs.net

A 45 year old man presented with a 6 month history of painful joints, cough, fever, and weight loss. He had a smoking history of 15 pack years. On examination there was synovitis of the hands, feet, and ankles. Radiographs were taken of the chest, ankle (fig 1), hands, and feet. The chest radiograph and computed tomography image of the thorax showed a lung mass. A biopsy found a poorly differentiated epithelioid …

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