Review Article

Vasculitis in Systemic Sclerosis

Table 2

Seven cases of medium- and-small vessel vasculitis associated with SSc.

CaseVasculitisAge/SexAg at
SSc Dx
SSc typeAge at Vasculitis DxPresentationDiagnosisOutcome

Pathak and Gobor [29]CNS45/F21L45Headache, confusion, seizure, aphasia; right face/arm/leg numbnessAngiography with abrupt cutoff in MCA branch, narrowing in ACA and MCA branches; leptomeningeal biopsy negativeImproved with methylprednisolone then cyclophosphamide

Kang et al. [28]PAN28/F28D28Brownish tender nodules on legsSkin biopsy: necrotizing arteritis in deep dermisStable on weekly methotrexate 20 mg

Jiménez López
et al. [30]
Mixed CG50/F50L50Paresthesias, vision changes, aphasia, delirium; rash on lips, palms, solesCryoglobulin /100mL Electroencephalogram: generalized slowing Cerebral angiogram: normal?

Barrett et al. [31]CF49/M38L49Sudden onset gangrene of fingers and toes; confusionCryofibrinogen 435 mg/L 40 Died despite Subcutaneous heparin and prostaglandin E1

Choy et al. [32]BD54/F54D16Oral/genital ulcers, superficial thrombophlebitis, rash, esophageal dysmotility, no tear production, left knee arthritisGrade II esophagitis ILD with restrictive PFTs Rash with pathergyUnresponsive to topical steroids; later azathioprine 100 mg daily, eye drops, D-penicillamine, colchicine; arthritis continued

Yokota et al. [33]BD62/M57L60Oral/genital ulcers, erythema nodosa, esophageal and gastric ulcers, chronic hepatitis C, pancytopenia?Esophageal ulcers resistant to prednisolone 30 mg daily;
died from pneumonia

Sugisaki et al. [34]RPC35/M31L35Left auricular ulcer and swelling; polyarthralgiaMRI: partial defect in
nasal septum
Improved with prednisolone 15 mg daily and not with antibiotics

CNS = central nervous system vasculitis; PAN = polyarteritis nodosa; Mixed CG = mixed cryoglobulinemia; CF = cryofibrinogenemia; BD = Behcet’s disease; RPC = relapsing polychondritis; SSc = systemic sclerosis; L = limited; D = diffuse.