26th February 2025

A 57-year-old male is seen in rheumatology clinic, having been referred by his general practitioner.

A 57-year-old male is seen in rheumatology clinic, having been referred by his general practitioner. He has been feeling generally unwell recently, with lots of ‘aches and pains’. He particularly comments on abdominal pain after eating, and his wife has commented that he has lost weight recently. He has also developed leg ulcers, which are being dressed by the district nurses but do not seem to be improving. On direct questioning, he does also complain of testicular pain.

On examination, you note leg ulcers bilaterally to the anterior shins. Abdomen is soft with very mild tenderness. Chest is clear. Blood pressure is 167/95, pulse rate 78, oxygen saturations 99% on room air, temperature 36.7 degrees. 

Blood tests are shown below:

What is the most likely diagnosis?

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