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A 72-year-old man presented to the emergency department with 5-year history of progressive bilateral distal arm weakness. There was bilateral atrophy of the thenar eminences (figure 1) and weakness of median-innervated hand muscles. There was sensory abnormality of the palm around the base of the first four digits. He also had non-pruritic shiny papules on the face and tongue, which were bilateral and worsening for the last 2 …
Contributors The case report was written by AT. It was edited by SS and TT. BP helped with English composition. The patient was in the direct care of AT.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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