Case 111

 A sixty nine year-old male presented in our hospital suffering from persistent cough for ten days and appetite loss. Skin eruption on hands and ear auricles came out seven days ago. He consulted with a local clinician and got some medicines which were not effective for cough and skin eruption. Chest radiograph demonstrated bilateral opacity (Fig. 1). Then, he was introduced to us for further investigation. He had no habit of smoking. He was basically healthy and played a golf once a week. Medical findings showed skin redness on anterior chest and bilateral cheeks like butterfly erythema, skin dryness on the tip of the right second digit and the bilateral ear auricles and their backs. He felt somehow hurts on bilateral shoulder and knee joints. Laboratory test revealed white blood cells 7800/mm³, eosinophils 6.2%, LDH 325 U/L, CRP 5.3 mg/dL, Ig E 472 IU/mL, and HbA1c 8.0 mg/dL. He agreed to receive chest CT for further examination (Figs. 2-4).

What is your diagnosis ?

1. Cryptogenic organizing pneumonia

2. Chronic eosinophilic pneumonia

3. Anti-neutrophils cytoplasmic antibody associated vasculitis

4. Clinically amyopathic dermatomyositis

5. Polymalgia rheumatica

answer

2018.7.4