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Dysphagia in a patient with palmoplantar keratoderma
  1. R Morgan
  1. Arrowe Park Hospital, Arrowe Park Road, Merseyside CH49 5PE, UK
  1. Dr Morgan

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Answers on p 678.

A 72 year old man was referred by his general practitioner with a four month history of dysphagia. Physical examination wasunremarkable with the exception of his hands and feet which showed hyperkeratosis on the palms (fig 1) and soles of his feet. Gastroscopy showed severe extensive oesophagitis (grade III) confirmed with multiple oesophageal biopsies. He was started on a proton pump inhibitor (omeprazole) and rescoped three months later. He still had oesophagitis at this time, although macroscopically it had improved; repeat biopsies again showed oesophagitis. A further gastroscopy three months later showed complete resolution of his oesophagitis confirmed by repeated oesophageal biopsies. He remains well and asymptomatic on omeprazole and continues to be followed up.

Figure 1

Hyperkeratosis on the patient's palms.

Questions

(1) What is the diagnosis?

(2) How is it inherited?

(3) What is the major complication?

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