LAUSR

A 31-year-old woman presented with shortness of breath on exertion for the past six months. The symptoms had progressively worsened during the past month. She had an episode of chest infection before her visit to the clinic. She also complained of intermittent lower limb weakness with bilateral large joint pain leading to difficulty in ambulation. In addition, she experienced intermittent episodes of non-specific joint pain of the hands and wrist associated with skin rash. She had no known medical illness. On examination, she was afebrile, mildly tachypnoeic, with normal vital signs. Examination of the hands showed hyperpigmentation and hyperkeratosis of the palms, as shown in Figure 1. There was no joint deformity or rash. Chest examination revealed bilateral fine inspiratory crepitations. The rest of the examination was unremarkable. Radiographic images are shown in Figures 2 and 3.