DR.MOHAMMED IRFAN SHEIKHabout 1 year ago

Image Challenge

A 53-year-old man presented with a 3-year history of an itchy rash, Raynaud’s phenomenon, dysphagia, and a burning sensation in his hands. Physical examination was notable for firm, greasy papules across his forehead that led to the formation of glabellar grooves (left). There were waxy papules on his hands, with associated skin thickening and finger flexion contractures (right). Similar skin changes were seen on his nose, lips, ears, trunk, and feet. There was no telangiectasia or calcinosis. Sensory neuropathy was present in his hands, arms, and face. Tests of thyroid function were normal. Serum protein electrophoresis with immunofixation identified an IgG-monoclonal gammopathy, and a bone marrow biopsy was normal. What is the most likely diagnosis? A.Light chain (AL) amyloidosis B.Multiple myeloma C.Scleredema D.Scleromyxedema E.Systemic sclerosis