Case 26

Background

A 64-year-old white male presented with 2 months of soreness of the muscles across his shoulders, lower back, and hips. The patient was also experiencing generalized fatigue and "heaviness" of the forearms after working. The sensation of heaviness in the forearms would start after he used his hands to do his usual daily activities and resolved after resting his forearms for a few minutes.
The patient did not have any complaints of Raynaud's phenomenon, joint pain, chest pain, abdominal pain, bitemporal headaches, jaw claudication, changes in his vision, or claudication of his lower extremities.
His past medical history was unremarkable. He had discontinued smoking 4 years earlier. There was no history of hyperlipidemia.
On physical examination, the patient was afebrile, but blood pressure could not be obtained in either arm. Upper-extremity pulses were absent bilaterally. No bruits were audible in the carotid or axillary areas and there were no digital ulcers. Cardiac examination was normal with no murmurs audible. Pulses in the lower extremities were normal. Bilaterally, temporal arteries were neither enlarged nor tender. There was no scalp tenderness. The joint examination was normal with no joint tenderness or synovitis. No other abnormalities were noted. A work-up was initiated.
On the basis of the patient's presentation, the differential diagnosis at this point would include which of the following?

The correct answer is 'E' All of the above.