15th July 2024

A 65 year old man is referred by his GP to the acute medical unit. He reports a 4-month

A 65 year old man is referred by his GP to the acute medical unit. He reports a 4-month history of haematuria, fevers and night-sweats. He is unsure if he has lost weight, however his wife reports looser clothes. He has had a cough for the last 2 weeks and is feeling more tired and lethargic. He also complains of pain along his shoulder and hip girdle, as well as in his left knee.

On examination, you note sweaty palms. His RR is 20, Saturations are 96% on air, HR 81, BP 171/88. He is apyrexial. Chest examination is unremarkable, as is abdominal examination. Blood tests show a Haemoglobin of 187 g/L, WCC 7.4, CRP of 22, Na 133, K 4.4, Cr 110, eGFR 55.

What is the most likely diagnosis?

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