Occam's Razor versus Saint's Triad

A 60-year-old woman with a history of seronegative rheumatoid arthritis presented to the emergency department with a 10-day history of worsening dyspnea on exertion, nonproductive cough, and fever and a 7-day history of pain in the right leg and buttock. Foreword In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage A 60-year-old woman with a history of radiologically confirmed seronegative rheumatoid arthritis presented to the emergency department with a 10-day history of worsening dyspnea on exertion, nonproductive cough, and subjective fever and a 7-day history of pain in the right leg and buttock, which limited her mobility. There was no sputum production, orthopnea, paroxysmal nocturnal dyspnea, or pleuritic chest pain. Response I would start creating my differential diagnosis by taking into account the relatively short time course of the symptoms and the clinical context in which they developed. Given the patient's underlying disease, I am considering several complications of . . .