A 56-Year-Old Woman With Paresthesia and Choking

Heidi Moawad, MD

Disclosures

December 26, 2018

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 56-year-old woman has had worsening paresthesias in her arms for several months. Within the past few weeks, she began to notice that lifting boxes at her job as a store stocker became more difficult. She gets exhausted climbing the stairs in her home, especially when she is carrying a full laundry basket. She does not regularly exercise, so she does not know whether her endurance has changed. She also has noticed that she occasionally coughs and chokes while she is eating and drinking, and she is wondering whether she may have the flu.

Her medical history is significant for mild springtime allergies, frequent urinary tract infections, and a kidney stone.

She does not smoke and drinks about one alcoholic beverage every few months, at social occasions only. She is not under any unusual stress. She lives with her husband. They have three healthy, adult children. Her husband smokes about one half of a pack of cigarettes per day.

Her family history is significant for a sister who has multiple sclerosis. Both of her parents were heavy smokers. Her father died of lung cancer, and her mother, who is living, has severe congestive heart failure.

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