Dee is a 42-year-old sales assistant who presents with one month of bilateral ear swelling and tenderness, with associated pain in both hands and fingers, and mild chest tightness.

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<p>Dee is a 42-year-old sales assistant who presents with one month of bilateral ear swelling and tenderness (right ear pictured), with associated pain in both hands and fingers, and mild chest tightness.</p><p>Dee is typically well, a non-smoker with no regular medications, allergies, occupational exposure risk or past history of note. On examination, vital signs are within normal limits.</p><p>There is firm erythematous nodular swelling affecting both pinnae, which are tender and warm to the touch.</p><p>There is also generalised bilateral metacarpophalangeal and phalangeal joint tenderness.</p><p>Cardiorespiratory examination is unremarkable. A chest CT reveals ground glass opacification with multiple pulmonary nodules and bilateral mediastinal lymphadenopathy.</p><p>Laboratory investigations reveal a normal FBC, UEC, CRP, ESR and negative IGRA for <em>Mycobacterium tuberculosis</em>.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.