Journal of the New Zealand Medical Association, 21-January-2011, Vol 124 No 1328
Sumit Chatterjee, Susmita Chatterjee
A 36-year-old male presented with generalised weakness, loss of appetite, hoarseness of voice and gradual onset of bilateral calf swelling during the previous 2 months. He also complained of symptoms suggestive of proximal muscle weakness of both his lower limbs, an excessive cold sensation and constipation during the same period.
There is no significant past history of any ailment nor any contributory family history.
General examination revealed mild pallor, facial puffiness and dry coarse skin. Pulse and blood pressure were 64/min and 120/90 mmHg respectively. Cardiac and respiratory system examination was normal. CNS examination showed hypotonia in all the four limbs, power grade 3/5 in both lower limbs proximally and 4/5 distally. Power in upper limbs was normal.
Deep tendon reflexes were normal throughout except for the ankle jerk which revealed delayed relaxation. Rest of the examination was normal.
Relevant investigations revealed the following:
Relevant photographs are shown below.
Question—Name the complete diagnosis
Author information: Sumit Chatterjee, Senior Resident, Department of Medicine, Calcutta National Medical College, Kolkata, India; Susmita Chatterjee, Medical Officer, Department of Medicine, CGHS, Mumbai, India
Correspondence:Dr. Sumit Chatterjee, E7/003, Peerless Nagar, P.O. Panihati, Kolkata, West Bengal, India 700114. Email: firstname.lastname@example.org
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