Unusual presentation of scleroderma

Scleroderma is a group of rare and complex diseases with varied clinical manifestations. The most obvious manifestation of the diseases is skin hardening and sclerosis. A 39-year-old woman presented with complaints of swelling of bilateral lower limbs. The patient also complained of spotty pigmentation of chest, back, and forearm. The patient gave history of weakness of left leg since 3 months. Antinuclear antibody (ANA), anticentromere, and antiDs DNA antibodies were negative. Clinical manifestations were unusual, as the patient had only edema and skin rashes. Visceral organ involvement was only in the form of abnormal liver function test especially lactate dehydrogenase (LDH). The patient also had grossly elevated creatine phosphokinase (CPK) suggesting muscle involvement, though symptom of muscle weakness was only mild. The patient was negative for antinuclear as well as anticentromere antibodies. Diagnosis in this patient was mainly based on skin biopsy findings.