🌪️ Medical Tale

🎬 Scene One – The Misleading Beginning

In the ENT department, Hoda, a 35-year-old woman, walked in complaining:

“Doctor, my nose is always blocked, I keep getting nosebleeds, and my voice has become hoarse. I’ve taken so many antibiotics, but nothing helps.”

Examination findings: • Mild septal perforation • Crusts inside the nasal cavity • Mild sinus tenderness

She was diagnosed with chronic sinusitis and given another course of antibiotics.

But a month later… things got worse. She developed bloody cough (hemoptysis) and shortness of breath. She was referred to the chest department.

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🎬 Scene Two – The Picture Grows Complex

In the chest unit, the CT scan showed: • Multiple lung nodules, some cavitating • No pleural effusion

Initial impression:

“This could be Tuberculosis… or metastatic disease.”

But the TB test was negative, and the abdominal CT was normal.

Two weeks later, her creatinine started rising, and urine analysis showed RBC casts.

The resident said nervously:

“So now she has both lung and kidney involvement?!”

The consultant looked up calmly from the scan:

“Exactly… the game has just entered the Rheumatology arena.”

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🎬 Scene Three – The Clinical Reasoning (The DDx Meeting)