05-19-2007, 06:51 PM
A 54-year-old man has a 3-week history of fever and migratory arthralgias and myalgias. The patient has New York Heart Association class IV congestive heart failure and had two previous myocardial infarctions. Lisinopril was discontinued approximately 10 weeks ago because of a refractory cough. Current medications are aspirin, diuretic agents, isosorbide dinitrate, and hydralazine, as the patient is reluctant to try an angiotensin-receptor blocking agent. He initially did well on the new regimen before developing transient arthralgias and fever [maximum daily recorded temperature 38.8 °C (101.8 °F)], which he managed with over-the-counter ibuprofen.
Physical examination discloses evidence of congestive heart failure and equivocal arthritis of both knees. A chest radiograph shows mild enlargement of the cardiac silhouette and several very small calcified hilar lymph nodes.
Which of the following is most likely causing this patient™s current findings?
( A ) Gout
( B ) Drug-induced lupus
( C ) Influenza
( D ) Gonorrhea
( E ) Tuberculosis
Physical examination discloses evidence of congestive heart failure and equivocal arthritis of both knees. A chest radiograph shows mild enlargement of the cardiac silhouette and several very small calcified hilar lymph nodes.
Which of the following is most likely causing this patient™s current findings?
( A ) Gout
( B ) Drug-induced lupus
( C ) Influenza
( D ) Gonorrhea
( E ) Tuberculosis