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JAMA Dermatology Clinicopathological Challenge
April 10, 2019

Abrupt Onset of Dysphagia, Arthritis, Joint Contractures, and Sheets of Monomorphous Waxy Papules

Author Affiliations
  • 1School of Medicine, Oregon Health and Science University, Portland
  • 2Department of Dermatology, Oregon Health and Science University, Portland
JAMA Dermatol. 2019;155(6):737-738. doi:10.1001/jamadermatol.2018.5627

A man in his 50s presented with dysphagia, arthritis, joint contractures, carpal tunnel syndrome, and infiltrated and redundant skin with sheets of 1- to 2-mm-wide waxy, firm, skin-colored papules. The patient first noticed papules on his forehead 1 year prior to presentation that spread to his face, trunk, and extremities. He had mild dysphagia and severe joint pain in his hands and wrists, with carpal tunnel of his right wrist. Additionally, his daily activities were impaired owing to decreased mobility. During clinical evaluation, he denied cough, shortness of breath, chest pain, Raynaud phenomenon, fevers, night sweats, weight loss, seizures, or confusion.

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