- Kent PD, Michet CJ, Luthra HS
- Curr Opin Rheumatol
A 30-year-old male presented to the Emergency Room complaining of feeling generally unwell with nausea and vomiting. He had been well until the morning of presentation, except for some symptoms of dyspnoea and a mild, stabbing pain in the left of his chest on deep inspiration. He had recently been investigated by the otolaryngologist because of hearing problems, and had been under the care of the rheumatologist for a year because of joint pain, red eyes and swollen painful red ears. He was taking non-steroidal anti-inflammatory drugs (NSAIDs) because of his joint pains and bronchodilatatory inhalation because of asthma. On examination he was afebrile and not in distress, blood pressure 110/60 mmHg, pulse rate irregular at 50 to 60 beats/min. On both ears the antehelix was nearly absent ( figure 1). Further general physical examination revealed no abnormalities. D-dimers were <500 ng/ml and troponin-I <0.20 mg/l, CRP was <5 (all normal). The chest X-ray was normal and the ECG is shown in figure 2.