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26th February 2025
A 57-year-old Caucasian male has been referred to rheumatology clinic by the respiratory physicians.
A 57-year-old Caucasian male has been referred to rheumatology clinic by the respiratory physicians. He has recently been diagnosed with asthma and has required multiple courses of oral steroids on top of optimal inhaled therapy to get this under control. He tells you he has had a funny rash on his legs, which isn’t going away, and he feels generally tired and run down. On direct questioning, he admits he does have regular drenching night sweats.
He has never smoked, he drinks moderately, and he has never left the United Kingdom.
On examination you note a petechial rash bilaterally to the lower limbs.
His blood tests are shown below:
| Admission | Normal range | |
|---|---|---|
| Hb | 136 | (135-170) |
| WCC | 12.4 | (3.5-11.0) |
| Plt | 411 | (140-400) |
| Neut | 9.2 | (1.7-7.5) |
| Eosinophils | 7.9 | (0.0-0.5) |
| ESR | 78 | |
| Urea | 4.5 | (2.9-8.2) |
| Creatinine | 98 | (66-112) |
| eGFR | >90 | |
| CRP | 82 | (0-5) |
| ANCA | Negative | |
| PR3 Ab | <1 | (0-3) |
| MPO Ab | <1 | (0-5) |
What is the most likely diagnosis?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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