Case 208

 A seventy two-year-old male suffered from neck pain, unable to rise his upper extremities, wrist pain and swollen dorsum of hands for a week. He had non-steroid anti-inflammatory drugs by himself but it did not abate him. Body temperature was 37.6°C.　Medical findings figured out skin eruption on fore-arms and tenderness on cervical spinous process and para-vertebral muscles. Laboratory test revealed CRP 29.85 mg/dL, WBC 22960/mm³, platelet 482000/mm³, D-dimer 14.8μg, serum ferritin > 5000 ng/dL (20-280), AST 78 IU, ALT 91 IU, creatinine 1.11 mg/dL, interleukin 2R 2600 U/mL (157-474).
 He agreed to take CT (Fig.1) and MRI (Figs 2-4).

What is your diagnosis ?

1.　Cardiac failure

2.　Malignant lymphoma

3.　Adult’s Still disease

4.　Polymyalgia rheumatica

5.　Remittent seronegative symmetrical synovitis with pitting edema

answer

2020.10.14