A 75 year old woman presents with "aches and pains." She complains of soreness and stiffness in her shoulders and hips in the morning. This can last from half an hour to an hour. Her neck and torso are also affected. The symptoms are symmetric. This all started pretty abruptly. The symptoms are so bad she has trouble dressing herself; once, she couldn't even get out of bed. She can't abduct her shoulders past 90 degrees. Nevertheless, she has normal muscle strength. During the rest of the day, the stiffness and ache occurs if she has been sedentary and tries to do something. She also has the findings in the image above. Social history is significant for being of Scandinavian descent. Review of systems is notable for malaise, fatigue, depression, anorexia, weight loss, and low-grade fever.
Challenge: What is your diagnosis?
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dermatomyositis, it is often paraneoplastic.. so you should be on the look out for a tumor!
ReplyDeletepolymyalgia rheumatica? Would check a sed rate and hsCRP and consider short course of glucocorticoid therapy to reduce inflammation
ReplyDeletealthough dermatomyositis is definitely on the differential, i was thinking of PMR
ReplyDelete-
Scandinavia I
This is polymyalgia rheumatica. The image shows swelling and pitting edema which can also be seen in PMR.
Source: UpToDate.