Patient complaining of finger stiffness and dysphagia. What could be the most probable diagnosis: March 2005
Ans. D: Scleroderma Diagnostic criteria for scleroderma: A.Major criterion: Proximal scleroderma is characterized by symmetric thickening, tightening, and induration of the skin of the fingers and the skin that is proximal to the metacarpophalangeal or metatarsophalangeal joints. These changes may affect the entire extremity, face, neck, and trunk B.Minor criteria Sclerodactyly is characterized by thickening, induration, and tightening of the skin, limited to only the fingers. Digital pitting scars or a loss of substance from the finger pad: As a result of ischemia, depressed areas of the fingeips or a loss of digital pad tissue occurs. Bibasilar pulmonary fibrosis includes a bilateral reticular pattern of linear or lineonodular densities most pronounced in basilar poions of the lungs on standard chest roentgenography. These densities may assume the appearance of diffuse mottling or a honeycomb lung and are not attributable to primary lung disease. Internal organ derangement in Scleroderma: Skin involvement-skin thickening Raynaud's phenomenon Esophageal involvement-heaburn, regurgitation and dysphagia Pulmonary fibrosis Pulmonary aerial hypeension Myopathy Cardiac involvement Scleroderma renal crisis
Achalasia
Lower esophageal ring
Esophageal carcinoma
Scleroderma