Clinical exam skills: A handy sign
A 32 year old woman presented with an eight month history of being “out of sorts.” Five months before she had had an elective ear, nose, and throat procedure in a district hospital. In the months after her admission she had regularly visited her general practitioner with a number of symptoms, which included tiredness, joint pains, facial pains, and a recurrent stuffy nose. At the time of admission to hospital in addition to the above she complained of sore red eyes.
On examination, there was evidence of bilateral conjunctival injection. She had tender small joints in the hands, knees, ankles, and elbows. Nail fold infarcts were also noted (fig 1).
Respiratory disease is associated with shortness of breath, cough, and haemoptysis. Chest radiography typically reveals one or several lesions (infiltrates or nodules) which are cavitating in nature. This may be confused with a cavitating pneumonia or a cavitating bronchial carcinoma