The patient, a 64-year-old male, began to have redness and pain in both ankles after walking in the afternoon in late November 2005, without morning stiffness, rash, mouth ulcers, or fever, which was slightly relieved by rest for about 10 days without treatment, and the symptoms recurred thereafter. The symptoms recurred 10 days before hospitalization and were accompanied by bilateral shin sunken edema and bilateral knee pain with a feeling of hypothermia but no temperature measurement, no cough or sputum. He was admitted to the hospital in April 2006 due to unbearable pain. There was no significant weight loss after the onset of the disease. He had a smoking history of 10 cigarettes per day for nearly 40 years. He had an ESR of 95 mm/h, WBC of 10.0×109/L, N of 79.6%, HB of 124 g/l, Plt of 296×109/L. On admission, T of 38oC, P of 92 beats/min, respiration of 20 breaths/min, Bp of 90/65 mm Hg. There was no enlargement of superficial lymph nodes, no cardiopulmonary auscultation, abdomen was flat and soft, no pressure pain, liver and spleen were not enlarged under the ribs. There was no enlargement of the liver and spleen under the ribs, no percussion pain in both kidney areas, redness and swelling with pressure pain in the medial part of both ankles, elevated skin temperature, pressure pain in both shins and both knees, no redness and swelling, mild depressed edema in both lower limbs. After admission: CRP 81.3mg/L, RF (-), biochemical analysis: TP 57.38G/L, ALB 33.0G/M, FIB 57.3G/L, thyroid series: TT3 1.0ng/ml, FT3 2.3pmol/L, FT4 6.5pmol/L, STSH 2.4mmol/L; immunoglobulin, antinuclear antibody series, ANCA, HLA-B27, D-dimer, and urine and stool routine were not different. Chest X-ray (Figure 1) suggested left upper lung cancer, left ankle and left knee X-ray (Figures 2 and 3) suggested: left heel bone spur, no abnormal knee joint, tibial periosteal hyperplasia; CT (Figure 4) suggested: left upper lung occupancy, right lower lung alveolus, left small pleural effusion, mediastinal lymph nodes did not show enlargement. Skeletal ECT (Figure 5) suggested that the systemic skeletal metabolic images were consistent with pulmonary hypertrophic bone disease. After admission, he was given symptomatic supportive treatment such as Yunque (99Tc-MDP) and Emmerich, and the joint pain improved significantly and was discharged automatically.
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