Answer 32

 

An answer emailed by Dr. Ahmed Aly Hassan :

"..In the light of the previously mentioned data: the combination of the neurological symptoms that appeared in the 2nd decade of life which is progressive involuntary movements to the presence of both hemolysis (clinically and laboratory) and hepatitis (which is not viral in origin) raises the suspicion of Wilson's disease or hepato-lenicular degeneration so, the pathognomonic physical sign I want to look for is the presence of Kayser-Fleischer ring at the corneo-scleral interface  .."

-Thank you Dr. Ahmed

 

Another answer emailed by Dr. Ali Abu Taleb:
"..Bone marrow aspiration and coomb's test Hemolytic Anaemia ..."

-Thanks Dr. Ali, but what is the cause of hemolysis?

 

Another answer emailed by Dr. Yahya Emara:

"..Kayser-Fleisher ring is the phathognomonic sign of Wilson's disease, can affect both the BG resulting in chorea and the liver Affection, may be haemolytic anaemia resulting in secondry haemosidrosis in which the iron will precipitate in BG and liver  affectiion.."

Welcome Dr. Yahya, and thank you for your answer.

 

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The answer:

It was a case of Wilson's disease and the pathognomonic physical finding is the "Kayser Fleischer rings" which are brown or greenish brown rings due to copper deposition at the sclero-corneal junction that characterize the Wilson's disease.