Fever, ulcers and joint pain: an incidental finding of oesophageal dysmotility.

A 41-year-old Bangladeshi man presented with a 2-month history of bilateral feet/hand swelling which intermittently resolved without medication. All blood tests performed by the general practitioner (GP) were unremarkable. Following admission to the accident and emergency department, a chest X-ray revealed a 'vail-like' opacification in the right side. High-resolution CT confirmed dilation of oesophagus with food debris and circumferential thickening of the lower oesophageal sphincter.