A 75-year-old man presented with a four-day history of periorbital erythema with oedema (figure 1) and ragged cuticles with periungual erythema (figure 2). Additionally, he developed progressive symmetric muscle weakness in the upper limbs and head-neck area, including difficulty swallowing. He had no fever. Laboratory testing revealed an elevated C-reactive protein of 39 mg/ml (normal value < 10 mg/ml), an elevated creatinine kinase of 3978 IU/l (normal value < 171 IU/l), and a lactate dehydrogenase of 511 IU/l (normal value < 248 IU/l).
WHAT IS YOUR DIAGNOSIS? See page 300 for the answer to this photo quiz.