Case 44491

Presentation of CaseA sixty-eight-year-old man entered the hospital because of pain in the back.Six weeks previously, while attempting to lift another person, he felt a "catch" in his back. Subsequently, there was increasing pain in the back. X-ray films of the chest at another hospital two months before entry showed prominent pulmonary markings bilaterally and an area of infiltration in the right infraclavicular region that had "the appearance of minimal tuberculosis." Four weeks before admission the patient noticed paresthesias in the left first finger, and thereafter paresthesias also occurred in the left hand, forearm and elbow. There was . . .