A train driver with painful legs

Abstract

A 45-year-old Portuguese man was admitted to hospital in March, 1997, complaining of a dull continuous pain in his lower legs since 1994. He used to work as a long-distance train driver but had to retire because after a few hours at work, the pain got so severe that he had to remove his foot from the safety lever which triggered the alarm and brought the train to a halt. Since 1994 he had had three episodes of high fever, each lasting about 3 weeks. Investigations at another hospital during one of these episodes failed to reveal a diagnosis but his erythrocyte sedimentation rate (ESR) was persistently over 100 mm/h.