Older Still...

In April, 2011, a 52-year-old man presented to us with a 7-day history of fleeting joint pain and stiff ness of his hips, right elbow, left shoulder, and lumbar region. The symptoms were worst in the evening and accompanied by myalgia in his quadriceps and gastrocnemius muscles. He had been unwell for 3 weeks with a swinging fever (>39°C), sore throat, cervical lymphadenopathy, and an intermittent pink rash across his chest, arms, and thighs. He had had no previous similar episodes and no recent diarrhoea, genitourinary symptoms, or red eyes. He denied any new sexual partners or travel to the tropics. On examination, he was febrile (temperature 39·2°C). He had swelling and reduced movement of his right elbow and left shoulder and discomfort on mobilisation of his lumbar spine. A striking pink rash covered his chest, arms, and thighs. There was no palpable lymphadenopathy or abdominal mass. Mehr