2017 Volume 50 Issue 3 Pages 207-212
An 83-year-old female had noticed symptoms of Raynaud’s phenomenon during the past 4 years. She was admitted to the cardiovascular department of our hospital so that the cause of her recurrent syncope could be investigated. The patient was suffering from hypertension, cardiac enlargement caused by pericardial effusion, bilateral pleural effusion, and acute kidney damage. We diagnosed her with sine scleroderma because she exhibited Raynaud’s phenomenon; extension of the nail epithelium; dilated finger pad capillaries; and positivity for anti-nuclear antibody, anti-centromere antibody, and anti-RNA polymerase III antibody, but did have any cutaneous symptoms. She also displayed grade III Keith-Wagener hypertensive retinopathy of the fundus, hemolytic anemia with crushed red blood cells, thrombocytopenia, and elevated renin-aldosterone system activity. As a result, we diagnosed her with sine scleroderma accompanied by a hypertensive scleroderma renal crisis. Finally, hemodialysis was initiated because her renal dysfunction did not improve in spite of good blood pressure control being achieved with calcium antagonists and enalapril. We describe this valuable case with reference to reports of previous cases of sine scleroderma that did not involve diffuse cutaneous sclerosis or rapidly progressive cutaneous sclerosis, which might be risk factors for hypertensive scleroderma renal crisis.
