1. In the name of god

2. 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.

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

4. 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.

5. 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

6. 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

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

15. 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

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

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

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

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

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

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

22. DDx:
scleroderma
generalized morphea
eosinophilic fasciitis
scleromyxedema