A case of Red Eyes, Foot Gangrene and Multiple Lung Nodules..
*38 yr old male presented to the opd with history of
- REDNESS OF EYES for 3 months
- JOINT PAIN
- LOW GRADE FEVER for 2 months
* Also complained of numbness and tingling sensation in right foot and dull chest pain for 1 month.
* 10 days ago he noticed blackening of skin and loss of sensation in right food and skin ulceration on right scapula.
* There has been history of nasal crusting and mucosal ulceration.
* No history of cough, expectoration, hemoptysis, shortness of breath. no history of urinary complaints, no alteration in bowel habits.
* Farmer by occupation and has SMOKING history of 30 PACK YEARS. His past, personal, family and drug history is not significant.
* BP 128/84
Pulse rate 76/min. temp 100° F
* On EYE examination, we found SCLERITIS, CORNEAL EDEMA and CONGESTION bilaterally.
* Ulceration wast +nt in the nose and para nasal sinuses and crusting was present in nasal mucosa, oral mucosa was normal.
* A punched out skin ulcer of size 3x2 cm was present on right scapular area.
* The big toe and second toe of right foot were found gangrenous with loss of sensation. the surrounding are was cold.
* Chest examination was normal. abdomen
was found soft and non-tender, there was no organomegaly. Cardiovascular system was found to be normal.
How to proceed further with investigation.....?