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A 62-year-old Indian woman presented initially in 1993 with swallowing difficulty, limb weakness, bilateral ptosis and Raynaud’s phenomenon. Investigation revealed an elevated creatine kinase and muscle biopsy suggested polymyositis. She responded well to treatment with prednisolone and azathioprine, which was gradually reduced and finally discontinued in 2004. She re-presented acutely unwell in 2006 with weight loss, dysphagia and gross weakness. Examination revealed cutaneous calcinotic plaques in both thighs and buttocks (fig 1), bilateral ptosis and global limb weakness. She was unable to stand erect, walking with a bent spine (fig 2A).
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