Endgames Spot Diagnosis

Dysphagia and a rash

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1590 (Published 10 May 2018) Cite this as: BMJ 2018;361:k1590
  1. Michael McFarlane, gastroenterology SpR,,
  2. Ben Disney, consultant gastroenterologist
  1. University Hospital Coventry and Warwickshire, Coventry, UK
  1. Correspondence to M McFarlane mmcf1982{at}doctors.org.uk

A 58 year old man presented with a six week history of muscle weakness, dysphagia, and a symmetrical widespread rash on the face, torso, limbs, and hands (fig 1). His creatine kinase was 7070 u/L (reference range 30-175). An oesophagogastroduodenoscopy showed abnormal findings, and a positron emission computed tomography (PET CT) scan was arranged (fig 2). What are this man’s dermatological and oesophageal diagnoses?

Fig 1

Dorsum of the patient’s right hand

Fig 2

PET CT image

Answer

Gottren’s papules (fig 1) suggest acute dermatomyositis, and the high uptake of fluorodeoxyglucose in the mid oesophagus (fig 2) suggests oesophageal …

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