Thanks for all of your great responses to our question of the day – some good analyses and discussion.
So here we go with the likely pathology …
- Symmetrical findings make a central lesion less likely (they would localise).
- The reflexes and sensation are intact, making a cord or peripheral nerve lesion unlikely.
- The absence of fatigability makes a neuromuscular junction lesion less likely (myasthenia etc).
- This sounds like a myopathy: the rash therefore suggests polymyositis (the rash is a heliotropic rash named after the purple heliotrope flower). The CK is likely to be very high (in the thousands, NR <150 iu/l).
- The dysuria and cough are intended as distracters.
Look out for our next question of the day coming soon, and remember there are thousands more in the login area!