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Also, a subset of patients evolve into a clinical picture more consistent with a major diffuse connective tissue disease. We present the case of a 50-year-old black woman whose inaugural presentation of MCDT was oropharyngeal dysphagia, symmetrical proximal muscle weakness, tongue atrophy and skin sclerosis. High-dose corticosteroids and methotrexate were given with little improvement, maintaining disabling dysphagia leading to a percutaneous endoscopic gastrostomy tube placement. She was then started on intravenous immunoglobulin with progressive remission of symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2017-223699","type":"journal-article","created":{"date-parts":[[2018,3,5]],"date-time":"2018-03-05T09:15:37Z","timestamp":1520241337000},"page":"bcr-2017-223699","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Following leads: connecting dysphagia to mixed connective tissue disease"],"prefix":"10.1136","volume":"2018","author":[{"given":"Rita de Sousa","family":"Gameiro","sequence":"first","affiliation":[{"name":"Medicina Interna, Hospital Beatriz \u00c2ngelo, Loures, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Isabel Alves","family":"Reis","sequence":"additional","affiliation":[{"name":"Medicina Interna, Hospital Beatriz \u00c2ngelo, Loures, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Cristina","family":"Grilo","sequence":"additional","affiliation":[{"name":"Medicina Interna, Hospital Beatriz \u00c2ngelo, Loures, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Noronha","sequence":"additional","affiliation":[{"name":"Medicina Interna, Hospital Beatriz \u00c2ngelo, Loures, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,3,5]]},"reference":[{"key":"2025082804195666000_2018.mar05_1.bcr-2017-223699.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.143792"},{"key":"2025082804195666000_2018.mar05_1.bcr-2017-223699.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2012.01.009"},{"key":"2025082804195666000_2018.mar05_1.bcr-2017-223699.3","doi-asserted-by":"publisher","DOI":"10.1177\/0961203310376637"},{"key":"2025082804195666000_2018.mar05_1.bcr-2017-223699.4","first-page":"OD05","article-title":"A rare case of mixed connective tissue disease (MCTD) with intricate features of lupus, polymyositis and rheumatoid arthritis presenting with severe myositis","volume":"9","author":"S","year":"2015","journal-title":"J Clin Diagn Res"},{"key":"2025082804195666000_2018.mar05_1.bcr-2017-223699.5","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(72)90064-2"},{"key":"2025082804195666000_2018.mar05_1.bcr-2017-223699.6","unstructured":"Bennett R . 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