Case 4-1970

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Abstract
Presentation of CaseA sixty-five-year-old woman was admitted to the hospital because of weakness and fatigue of two years' duration.She had been well until two years previously, when there was the onset of increasing fatigue, exertional dyspnea, cold intolerance and constipation. Coarsening of the hair and thickening of the skin of the hands and feet occurred. On exposure to cold she experienced painful blanching of the hands, followed by erythema, numbness and tingling. Ten months before admission she began to have frequent eructation and regurgitation of food, without nausea or abdominal pain. Undigested food particles were produced during nocturnal . . .