Medical Challenge | Muscle Weakness

Posted on August 27, 2011

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A 60 year old white male presents with a primary complaint of muscle weakness.  He is a mechanic and has been having a progressively difficult time carrying some of the heavier parts around his shop.  His past medical history is significant for hypertension and osteoarthritis, and his family history is non-contributory.  He smokes 2 packs of cigarettes daily and consumes about 2 six-packs of beer weekly.

Review of systems:

  • General fatigue
  • No changes in vision or hearing recently
  • Self-reported weight loss of 10 pounds over the past two months
  • Chronic productive morning cough
  • Occasional shortness of breath
  • “Heart burn”, self-medicated with OTC antacids
  • No urinary urgency, frequency, or burning
  • Recent “eczema” that OTC creams have not resolved

Exam:

  • T: 99F  BP: 138/86  P: 60, regular  RR: 18
  • Pupils are equal in size and reactive to light
  • Cranial nerves II-XII are grossly intact
  • Cardiopulmonary exam is unremarkable
  • Abdomen is soft, non-tender and non-distended; liver & spleen are non-palpable
  • Symmetric 4/5 strength (weakness against resistance) of the proximal muscle groups
  • Symmetrically 2+ reflexes with downgoing plantar response (normal)
  • Vibratory, pinprick, temperature & proprioception intact bilaterally (no sensory deficits)
  • Patchy, erythematous (red) rash over the back of the hands and fingers

A chest x-ray shows the following:

Click to enlarge.

Given the history and findings, what is the most likely diagnosis?

A) Myasthenia gravis

B) Peripheral neuropathy

C) Lung infection/pneumonia

D) Polymyositis

E) Dermatomyositis

F) Spinal cord compression

G) Creutzfeldt-Jakob disease

H) Guillain-Barrè syndrome

Leave your answer below and check back in 24-48 hours for the answer & explanation – good luck!

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Posted in: Medicine