Clinical presentation

A 29-year-old man presented to the hospital with progressive dysphagia and nausea. He also claimed recurrent episodes of nyctalopia (night blindness) in the past. His medical history includes a hepatocyte nuclear factor-1β gene mutation causing a chronic cholestatic liver disease.

On physical examination, epigastric tenderness was detected and there were multiple scaly plaques at the extensor sides of the upper and lower extremities (figure 1A).