15th July 2024

A 61-year-old gentleman is referred to a clinic with a 3-month history of feeling generally unwell, tired and nauseous

A 61-year-old gentleman is referred to a clinic with a 3-month history of feeling generally unwell, tired and nauseous.  He also complains of increasing shortness of breath.  He has a past medical history of hypertension for which he takes amlodipine and sinusitis for which he takes a beclomethasone nasal spray.  On examination, collapse of the nasal bridge is evident. He also has a wheeze and crackles throughout the chest. There are some small blistered erythematous lesions on his shins and forearms.  Investigations were as follows:

Which of the below options is the most likely to confirm the diagnosis?

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