CASE REPORT

A 48 year old white woman presented for evaluation of a 12 month history of progressive increasing skin thickness and tightening and recurrent falls. The patient was in her usual state of health until one year before admission when she noticed increased skin pigmentation with diffuse skin thickening, initially on the thighs but progressing to her abdomen and arms. She denied any Raynaud's phenomenon. On examination, the vital signs were normal. Examination was significant for skin thickening and induration of the thighs and arms. There was minimal sclerodactyly and no digital ulcers, scars or synovitis. No nailfold capillary abnormality was noticed. The oral aperture was mildly decreased with no evidence of telangiectasias. There were bilateral flexion contractures of the knees and the elbows. Results of chest, heart, and abdominal examinations were within …