BMJ 2014;349:g7445 doi: 10.1136/bmj.g7445 (Published 12 December 2014)

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Endgames

ENDGAMES PICTURE QUIZ

A man with generalised lymphadenopathy Rosalie Magro higher specialist trainee in general medicine and rheumatology, Andrew Borg consultant physician and rheumatologist Department of Medicine, Mater Dei Hospital, Tal-Qroqq, Msida, MSD 2090, Malta

A 75 year old man with Paget’s disease, hypercholesterolaemia, and hypertension presented with a three year history of multiple neck lumps, which had never been investigated and had increased in size over the past two months. He felt generally well and had no history of fever or weight loss. His appetite was normal and there was no change in bowel habit. Clinical examination showed no abnormalities and he had no shortness of breath, chest pain, lower limb oedema, joint pains, or neurological symptoms.

On examination, he had hepatomegaly (width of three fingers) and his cervical, axillary, and inguinal lymph nodes were enlarged, hard, and non-tender bilaterally. His blood count, renal function, and C reactive protein (

A man with generalised lymphadenopathy.

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