Viriligo and Motor Neurone Disease Following Acute Polymyalgia Rheumatica

CASE REPORT A 73 year old man, still manually employed at a golf club, consulted his general practitioner (P.R.) with stiffness and pains in his neck, shoulders and back. The strong clinical impression of acute polymyalgia rheumatica was confirmed by an erythrocyte sedimentation rate (E.S.R.) of 64mm/one hour and an immediate improvement with prednisolone. J One month later he developed widespread skin erythema especially over light exposed parts, and was left with large depigmented areas over his hands. arms, neck and trunk. An initial diagnosis of actinic reticuloid was made but was later changed to one of vitiligo (Dr J. L. Hawk, St. John's Hospital for Diseases of the Skin). Some nine months after his initial presentation he began to complain of muscle weakness for the first time he was unable to unscrew bottle tops; he found turning over in bed difficult and required help to sit up in or climb out of bed; he walked with increasing hesitancy and fell more frequently. He admitted to two years of calf muscle cramps and these may represent the onset of his neurological disease.'