Regression of skin changes in a patient with systemic sclerosis

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British Journal of Rheumatology 1998;37:696–706

LETTERS TO THE EDITOR gests the possibility that correction of nutritional deficiencies in scleroderma patients may have a beneficial effect on skin tightening.

Regression of Skin Changes in a Patient with Systemic Sclerosis Following Treatment for Bacterial Overgrowth with Ciprofloxacin SA 47-yr-old woman presented with sudden-onset joint pain, muscle weakness and swelling of the lower limbs. Examination revealed diffuse oedema of all limbs, proximal muscle tenderness and weakness, and periungual erythema. The creatine kinase level was raised (542 IU/l, 98.1% CKMM fraction) and myositis was confirmed by muscle biopsy. Antinuclear and Jo-1 antibodies were positive. Her serum albumin was low at 30 g/dl, but renal function was normal with negative dipstick urinalysis. She was commenced on 60 mg of prednisolone with symptomatic improvement. Ten months later, she developed sclerodermatous skin tightening of her hands, forearms, face, calves and feet (confirmed by a right forearm skin biopsy), Raynaud’s phenomenon and watery diarrhoea (20 motions a day). She lost 10 kg in weight, her serum albumin was 24 g/l and changes on a small bowel meal suggested systemic sclerosis. A lactulose hydrogen breath test confirmed bacterial overgrowth, serum B12 levels were low (137 mg/l ) and a normal jejunal biopsy excluded coeliac and Whipple’s diseases. Her ANA remained positive, but scl-70 and anticentromere antibodies were negative. She received 4 month courses of first tetracycline then metronidazole, but her diarrhoea persisted; she lost a further 12 kg in weight, her albumin remained

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