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A 46-Year-Old Woman Presents With Difficulty in Ambulation, and Swelling and Discoloration of Both Eyelids

A 46-Year-Old Woman Presents With Difficulty in Ambulation, and Swelling and Discoloration of Both Eyelids

A 46-year-old woman presented for medical evaluation due to a 2-month history of increasing difficulty in ambulation, especially getting up out of a chair or climbing stairs. She had also noticed swelling and discoloration of both upper eyelids (as depicted) and some small erythematous papules on the dorsum of several fingers on both hands. Routine blood work was within normal limits except for an elevated erythrocyte sedimentation rate (ESR).

Both creatine phosphokinase (CPK) and aldolase were markedly elevated. It would also be advisable to order which additional test(s)?
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