A Case of Systemic Sclerosis with Myositis overlap syndrome.
A 22 yr old female attended Mopd with B/L pain and gradually progressive weakness in thigh and shoulder.
Pt also Complains of skin hyperpigmentaion and skin thickening over distal leg and arm since 2019.
No H/O Trauma,LOC,Back pain,vomiting headache,burning sensation in eye,dysuria,chest pain,SOB,Dysphagia,Heart burn ,change in color of digits on exposure to cold etc.
She is known Hypothyroidism.
No H/O HTN,T2DM,Substance abuse.
No similar family History.
Normal Menstrual cycle.
O/E there is pallor.
Cyanosis,clubbing,icterus,edema absent,no lymphadenopathy or Thyroid mass.
Normal Mental status,pt is well oriented to Time, Place and Person.
Normal spine and no meningeal signs.
Normal sensory Examination.
Normal cerebellar findings.
Motor - Muscle power is -4/5 in shoulder flexor and extensor, abductor and adductor group on both side ,also flexor and extensor group across elbow joint and wrist jt.
Power is -4/5 in all ms group of Hip. +4/5 across knee and ankle jt.
Jerks Normal,plantar flexion,Normal tone.
CVS -S1/S2 audible,no added sounds.
Chest- B/L clear,No added sounds,No velcro crepts.
P/A soft,BS +,No organomegaly.
Reports done are showing
Raised ANA of 86.8
Raised TSH of 12.37
Low Vit D less than 8
Low Vit B 12 of 161
Low Hb of 9.7.
Reports arrived showing Raised CK more than 2000,raised anti centromere Ab,Normal anti SCL 70.
The pt is suspected to be having connective tissue disorder.
Her ANA is positive with speckled pattern which is seen in Dermatomyositis, Mixed connective tissue disorder,Dermatomyositis and Systemic Sclerosis.
Her ds DNA is positive.