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Joint pains, hoarseness, and deafness
  1. N Younis,
  2. I F Casson
  1. Department of Medicine, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
  1. Dr N Younis, 7C link, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP, UK naveedy{at}tinyonline.co.uk

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Answers on p 280.

A 60 year old woman presented with a six week history of symmetrical joint pains affecting her large joints, associated with night sweats and weight loss. Recently she had noted hoarseness of her voice. She had no other relevant history apart from type 2 diabetes for 10 years. Clinical examination revealed stridor and conductive nerve deafness and the abnormality shown in figs 1 and 2. Investigations revealed a normocytic normochromic anaemia with a haemoglobin of 89 g/l and an erythrocyte sedimentation rate of 83 mm/hour. She had normal chest radiography and negative rheumatoid factor and antinuclear factor antibodies.

Figure 1

Lateral facial view (photograph reproduced with patient's permission).

Figure 2

Frontal facial view (photograph reproduced with patient's permission).

Questions

(1)
What is the most likely diagnosis and the differential diagnosis?
(2)
What further investigations should be performed?
(3)
How would you treat this condition?

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