Improvement of skin sclerosis after occurrence of anticentromere antibody in a patient with diffuse cutaneous systemic sclerosis.
A 38-year-old woman had noticed sclerodactylia and Raynaud's phenomenon 10 months before consultation. She was diagnosed as having systemic sclerosis (SSc) based on the skin sclerosis of her arms, chest, and face. Antinuclear antibody (ANA) level was 1:1280 with a speckled pattern, but specific autoantibodies were negative. Following the treatment with oral prednisolone and D-penicillamine, her skin sclerosis gradually improved. Three months after initiation of prednisolone, she presented Pneumocystis carinii pneumonia. About 1 year after the first admission, the pattern of indirect immunofluorescence staining changed from the speckled pattern to the discrete speckled pattern, and simultaneously anticentromere antibody (ACA) was detected by enzyme-linked immunosorbent assay. Her skin sclerosis rapidly and remarkably improved after appearance of ACA. It is generally considered that once certain SSc-specific autoantibody occurs, it does not disappear and change into other specificity of autoantibody thereafter. This case suggests that the presence of ACA closely correlates with clinical features and also suggests that clinical features may change during the clinical course with the appearance of another specific ANA. This case is very rare because such a case was not reported previously.
Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan.
Ikuko
I
Hayakawa
Shinichi
S
Sato
Takeshi
T
Echigo
Fumiaki
F
Shirasaki
Minoru
M
Hasegawa
Kazuhiko
K
Takehara
D000284:Administration, Oral; D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D018501:Antirheumatic Agents / Q000627:therapeutic use; D002503:Centromere / Q000276:immunology*; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D010396:Penicillamine / Q000627:therapeutic use; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000276:immunology / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D012595:Scleroderma, Systemic / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*; D012867:Skin / Q000473:pathology
D019268:Antibodies, Antineutrophil Cytoplasmic; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D011239:Prednisolone; D010396:Penicillamine