11th July 2023

A 68-year-old male patient was admitted to ED with shortness of breath

A 68-year-old male patient was admitted to ED with shortness of breath. His CXR revealed bilateral pleural effusions. Upon questioning, the patient admits to frequent episodes of facial pain and upper respiratory tract symptoms. On examination, you notice some nail changes (see image below).

Nail changes

What is the most likely clinical diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.