A 38-year-old male, a heavy smoker, was admitted to our department because of fever (38.4°C), weakness, arthralgias, non-pitting oedema of the lower extremities and chest discomfort for the previous two weeks. The arthralgias were partially responsive to nonsteroidal anti-inflammatory drugs (NSAIDs). The patient also reported skin eruptions on his elbows and lower extremities that had appeared six months previously. His past medical history was unremarkable.
Examination
On physical examination, sharply demarcated erythematous plaques covered by silvery-white scales were observed on the right elbow and the lower extremities below the knees. The patient's ankles were painful and oedematous. On palpation, firm and painless subcutaneous nodules could be found on the occipital part of the scalp. The rest of the physical examination was unremarkable. Radiographic examination, using x-ray and high-resolution computed tomography of the chest, revealed bilateral hilar and right paratracheal lymphadenopathy with small nodules along with the bronchovascular bundles.
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