Pulmonary infiltrates and skin lesions.

A 60-year-old man, a heavy smoker, was hospitalised because of a three-month history of pleuritic chest pain, dry cough and weight loss. He had lost 20 kg in weight and suppurative skin lesions began appearing on the chest wall. His medical history was unremarkable. On examination he was cachectic (44 kg) and pale. His temperature was 37.8°C. Important physical findings of the chest and neck are shown in figure 1. The axillary and neck nodes were enlarged and tender. Clubbing was present. Chest auscultation disclosed decreased breath sounds bilaterally, with no rales or ronchi. Non-tender, soft, small skin masses were observed and palpated on the chest wall. A chest X-ray and computed tomography (CT) scan were performed (figures 2 and 3).