Heavy Smoker With Clubbed Fingers, Pneumonia, and Arthralgias

The image at left shows the results of bone scintigraphy in a 61-year-old man who presented with fever, dyspnea, and productive cough of a week’s duration that did not respond to outpatient treatment with levofloxacin. He also had worsening arthralgias in his knees and ankles.

The patient has a smoking history of more than a pack a day. Physical examination revealed digital clubbing and decreased breath sounds on the right side, with scattered fine rales.

Can you guess at his diagnosis?

For the complete study including further imaging results, see A Patient With Nonresolving Pneumonia and Arthralgias.