AP, a 72-years-old man with hypertension, alcohol abuse and a previous tubercular pleurisy, is admitted to the local hospital because of a 2 weeks continuous fever (up to 38°C) with chills, cough, dispnea on mild exertion, asthenia; in the last 5 months he has had a weight loss of 8 kg, pain in both his arms with functional impairment, and a progressive swelling and stiffening of his fingers.Before hospitalization, AP has transient vomit and diarrhea, followed by syncope with sphincter incontinence.