The Indian Rheumatology Association

The Professional Organization of Rheumatologists and other Health Professionals in India

Case of The Month



Prepared By
SANKET SHAH
MDM resident
Clinical Immunology
JIPMER

Reviewed By
PUJA SRIVASTAVA
DM Clinical Immunology & Rheumatology (SGPGI, Lucknow)
MD Medicine (PGI, Chd), MBBS (AIIMS, Delhi) EULAR Certificate in MSK USG & Ped Rheumatology STAR Clinics (State of The Art Rheumatology Clinics)

Edited By
AVINASH JAIN
MD DM
International Research Fellow, UoB
Senior Research Fellow, SGPGI

Edited By
Dr CHENGAPPA
Assistant professor
MD DM
JIPMER

Courtesy
Dr VS NEGI
Professor and Head
Dept of Clinical Immunology
JIPMER

Stalking the diagnosis

Case Presentation

A 36-year woman, known case of diffuse cutaneous systemic sclerosis from eight months diagnosed in view of
  • Diffuse Skin thickening with MRSS (30/51)
  • Decreased mouth opening
  • Raynaud with digital ulcers
  • Polyarthritis
  • Interstitial Lung disease
  • Proximal weaknesswith no other neurological deficit.

Baseline Investigation


Complete blood count, Renal function test and liver function test – Normal
Creatine kinase- 75 units/L
Urine microscopy – normal
HIV, HbsAg, HCV- Negative
ECG – Sinus tachycardia, Normal axis
2D Echo - Mild TR, RVSP – 32, Normal LV function
HRCT thorax – Interstial Lung disease- NSIP pattern
Electromyography - Decrease in the mean duration of motor unit potentials
Muscle Biopsy - No endomysial inflammation. No evidence of myofiber regeneration or fibrosis

Serological Investigations


ANA -

4 + coarse speckled

ENA blot

Anti–U1 RNP -> 3 +
Anti-SSA -> 1 +