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 Best of Five 155

 

   

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BOF: 155

A 47-year-old male presents with sudden onset of a right-sided foot drop with numbness over the dorsum of his right foot. He has weakness of dorsiflexion and eversion of his right foot. There is an area of diminished sensation over the dorsum of the right foot. He also has a left wrist drop with loss of sensation over the dorsal aspect of the first interosseus space.  For the last few weeks he has had fever, he has been feeling unwell, he has lost weight and he has had aching of his muscles.

Investigations:

Hb 11.0 g/dL

MCV 90

WBC 12 x109/l

Neutrophils 8.5 x109/l

Lymphocytes 3.0 x109/l

Monocytes 0.3 x109/l

Eosinophils 0.1 x109/l

Basophils 0.1 x109/l

ESR 47 mm/1st hour

Urine:

Proteins ++

Blood ++

ANCA negative

The most likely diagnosis is:

a)      Sarcoidosis

b)      Systemic lupus erythematosus

c)      Rheumatoid arthritis

d)      Polyarteritis nodosa

e)      Churg-Strauss syndrome

 

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