A diagnostic conundrum of a “ring of fire”

A 36-year-old man presented to our hospital with a 2-week history of palpitations in the context of 3 months of a dry cough, weight loss, and night sweats.

The patient had no medical history, no recent foreign travel, and no contact with anyone who was unwell or
who had been exposed to tuberculosis. He had no notable family history; he was born in Ghana and had moved to the UK 12 years earlier.

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