Cape Breton, Nova Scotia
The patient is a 37 year old woman with a four year history of a slowly progressively asymptomatic area of induration on the posterior aspect of the left thigh (photo). A biopsy showed thickened collagen bundles in the reticular dermis and a sparse superficial and deep lymphoplasmacytic infiltrate consistent with morphea.
Strangely, her father-in-law is seriously ill with systemic sclerosis. He lives far from the patient and her husband. At this time, we have discovered no common exposures the patient and her father-in-law have. The patient lives in an endemic area for Lyme Disease and serological testing will be offered.
Questions:
Is there any value in obtaining serologies, other than Lyme studies, on this woman?
What treatment might be of value?
Do you have alternate diagnoses?
References:
1. Localized Scleroderma Review Article (Like a chapter in a text book)
2.
Morphea Sculpted in Silica: A Case Report of Limited
Cutaneous Systemic Sclerosis in a Woman with Long-Time Exposure to Silica Dust.
Pedro Gomes J, Shoenfeld Y.
Free
Full Text.
3.
"Borrelia-associated early-onset morphea": a
particular type of scleroderma in childhood and adolescence with high titer
antinuclear antibodies? Results of a cohort analysis and presentation of three
cases.
Prinz JC, et. al. J Am Acad Dermatol. 2009 Feb;60(2):248-55. CONCLUSION:B burgdorferi infection may be relevant for the induction of a distinct autoimmune type of scleroderma; it may be called "Borrelia-associated early onset morphea"
and is characterized by the combination of disease onset at younger
age, infection with B burgdorferi, and evident autoimmune phenomena as
reflected by high-titer antinuclear antibodies. As exemplified by the
case reports, it may take a particularly severe course and require
treatment of both infection and skin inflammation.
