In the name of god

Id : the patient is a 54 years old man who came here with cc of skin stiffness ,skin dryness, skin darkness of upper and lower extremities and trunk & inability to swallow solid food since one year ago. Skin involvement and dysphagia got worsen during this years. Patiant hasn’t any respiratory complaints(for example dyspnea. During this period patient refferd to doctor and recived some topical med but didnt improve.

PM HX: negative DRUG HX: negative Smoking:negative Family HX: negative Allergy: negative

P/E: v/s is normal BP of both upper extremity was 100/60 BP of both lower extremity was 110/60 All pulses was detected.

Skin examination: Skin hardness of upper trunk and upper back and areas distal to both elbow and knee Skin dryness, hyperpigmentation, loss of hair and shininess was seen in trunk and all extremities generally. Beaknose Ear calcinosis Sclerodactyly Flexion contraction in both 5th hand finger

salt& pepper sign (leukoderma of scleroderma) in ant surface of lt leg. There wasn’t any finger ulceration ,any telangiectasia Raynauds phenomenon was negative Finger swelling was negative Proximal weakness was negative Cappillary examination was normal

nail:normal hair:androgenic allopesia LAP: negative . heart exam: normal lung exam:normal organomegaly: negative force of limbs: normal

Lab data: ANA& Anti dsDNA: negative Lipid profile:normal LFT: normal FBS:70 ANA& Anti dsDNA: negative Lipid profile:normal LFT: normal ESR:41 U/A:normal TFT:normal

.S/E: normal Cortisol8am: normal Ca &P: normal CBC: WBC: 2.9 Hb:13.2 plt:197 .S/E: normal

GI consult: upper GI endoscopy was done and GERD was diagnosed and tab pantoprazole 40 mg qd was prescribed

Lung consult: Vbg:normal Spirometry:mild restriction CXR: intristitial involvement in both lung basis Spiral chest CT: Normal

Cardiology consult: PAP:25 EF:55% Nl LV size and function

Endocrinology consult: Cortisol 8am & TFT was orderd & both was normal

Hematology consult: CBc weekly till one month &if abnormal reconsult

DDx: scleroderma generalized morphea eosinophilic fasciitis scleromyxedema