Fever, myopathy, and pulmonary disease—the clue is in the hands
BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2022-072171 (Published 17 November 2022) Cite this as: BMJ 2022;379:e072171
- Fabio Torres-Saavedra, professor1 2,
- Lina León-Sierra, consultant3
- 1Rheumatology Group GRUA, Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia
- 2Department of Rheumatology, Clínica Nueva Sagrado Corazón, Medellín, Colombia
- 3Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
- Correspondence to F Torres-Saavedra fabio.torressav{at}gmail.com
A black woman in her 30s presented to the outpatient clinic with a five month history of fever, arthralgia, and dyspnoea. She had no known medical conditions. She reported no photosensitivity, oral ulcers, haemoptysis, digital ulcers, or dysphagia. Physical examination revealed bilateral 3/5 deltoid and quadriceps strength, hyperpigmented lesions on the palms, and a subtle hyperkeratosis with scales on the sides of the digits and fingertips (fig 1). No evidence of Raynaud’s syndrome was present. This was the first occasion on which the patient had sought medical help for her symptoms.
Hyperpigmented lesions on the palms and scaly, hyperkeratotic erythema on the sides of the digits and fingertips (“mechanic’s hands”)
Laboratory test results …
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