A middle-aged man who had a cadavaric renal transplant overseas 5 years ago presented with generalized tonic-clonic seizures followed by impaired consciousness. While he was being examined in the emergency department, the rather striking appearance of his palms and soles were observed.

(This is not an infectious disease diagnosis)Questions:

1. What is the clinical diagnosis?
2. How is this condition inherited?

[Updated on 16th June 2018]

This is a striking condition – very rare in Singapore. The diagnosis is diffuse palmoplantar kerotoderma, and the inheritance is variable (autosomal dominant, recessive, and even acquired). There are several articles that describe the condition well, including NIH and Wikipedia. Some variants are associated with oesophageal cancer.