PMC6913253_01
Silvery scaly lesions and plaques on the extensor surfaces of the hands and forearm.
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fig1
There were widespread silvery scaly skin lesions interspersed with hyperpigmented plaques all over his body but mainly on the extensor surfaces of the upper limb (Figure 1).
Resting 12-lead ECG obtained at presentation showing short PR interval, positive delta wave in V1 (type A Wolff-Parkinson-White pattern), and broad QRS complex.
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fig2
Resting ECG (Figure 2) revealed a regular sinus rhythm at the rate of 78 cycles per minute with a QRS axis of +90 .
Parasternal short axis (a) and long axis (b) views showing asymmetric septal hypertrophy.
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fig3
Two-dimensional transthoracic echocardiography revealed a maximum septal thickness of 27 mm at the basal anterior septum with a corresponding posterior wall thickness of 13 mm (Figures 3(a) and 3(b)).
Late peaking of flow (dagger shape) across the left ventricular outflow tract.
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fig4
Left ventricular outflow peak gradient was 36 mmHg, with a late peaking of velocity (Figure 4).