Can’t say I have a totally definitive answer, but so far it seems like signs are pointing to… syphilis! In general looking like it’s likely on the infectious spectrum. Wild look, so symmetric bilaterally!
Thanks for all the input everyone!
In no particular order some ideas thrown out there:
– Sarcoid
– Hypertrophic pulmonary osteoarthropathy / paraneoplastic syndrome (associated with the lung lesion)
– Infection (TB, syphilis, brucellosis)Will update if we get some answers!
Both hands look the same.
Normal creatinine, elevated CRP, normal CBC (mild anemia), all infectious studies negative so far (cultures etc, TB neg so far), normal PTH, normal calcium, normal phosphorus
Alk phos elevated
Nuclear medicine scan shows involvement of a few other areas in the lower extremities (looks like around the ankle)
Only other finding is a lung cavitary lesion. 2.5 cm. Pretty thin rim, doesn’t look like a cyst though.
Patient in their 30s. Presenting symptom was bilateral hand pain. Did report a somewhat recent hospitalization, unknown details but respiratory related, sounds like treated for pneumonia with antibiotics
