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All photographs reproduced with patient's permission. 2002;
Answers on p 109.
A 69 year old woman with no relevant past medical history was admitted with dysphagia. She reported difficulty swallowing both solids and liquids and that it had been gradually worsening over a 10 year period. She denied pain on swallowing and there was no history of regurgitation, heartburn, corrosive ingestion, or weight loss. There was a 25 year history of intermittent attacks of pallor, pain, and redness of the digits.
Comment on the appearance of her tongue (fig 1), face (figs 3 and 4), and hands (fig 5).
Comment on the appearance of her barium swallow (fig 2) and suggest a unifying diagnosis.
Examination of her left elbow revealed a hard nodule over the extensor aspect. What does the radiograph (fig 6) show?