The Indian Rheumatology Association

The Professional Organization of Rheumatologists and other Health Professionals in India

Case of The Month

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 +