Case presentation A 61-year-old man was presented for assessment of neck pain, stiffness, and occipital headache for four years. He also reported progressive thickening of the skin around his neck. Medical history The patient had a history of hypertension, type 2 diabetes, and hypothyroidism. He had no history of Raynaud's phenomenon, heart, kidney, liver disease, diabetic retinopathy, nephropathy, or neuropathy.
Medication history The patient reported that medications such as acetaminophen and meloxicam provided only partial relief. Antidiabetic medications include rosiglitazone, glimepiride, and levothyroxine. Social history The patient stopped smoking 24 years ago but drinks three glasses of wine per week. Physical examination: Bodyweight: 131.5 Kg Body Mass Index: 40.57 Heart rate: 82/min Blood Pressure: 161/89 mmHg Facial swelling and brawny periorbital edema were observed (Image…
