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An 81 year old man presented in October 2002 with a three week history of fatigue, generalised myalgia, increasing difficulty in getting up from the sitting position, and “pins and needles” sensation in both hands and feet. His past medical history included late onset asthma at the age of 66, which had gradually become worse over the past year, nasal polyps, and carcinoma of the bladder in 1991, which was removed by cystoscopy. His only medication was inhaled salbutomol as required.
He was unable to stand or walk without support at the time of admission and had generalised muscle wasting. He had grade 3 (Medical Research Council grading) proximal muscle weakness in both lower limbs and grade 4 proximal weakness in both upper limbs. His left handgrip was also weak. His blood pressure was 160/80 mmHg and urine showed a trace of …