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Mosaic capillaroscopic findings in systemic sclerosis.

Sevdalina Nikolova Lambova1, Ulf Müller-Ladner2,3

  • 1Faculty of Medicine, Department of Propaedeutics of Internal Diseases, Medical University Plovdiv, 15A "Vasil Aprilov" Blvd, 4002, Plovdiv, Bulgaria. sevdalina_n@abv.bg.

Wiener Medizinische Wochenschrift (1946)
|February 3, 2018
PubMed
Summary

This case highlights a "mosaic" pattern in nailfold capillaroscopy for systemic sclerosis (SSc). Comprehensive bilateral examination is crucial for accurate diagnosis of microvascular changes in SSc.

Keywords:
CapillaroscopyEndothelial damageMicroangiopathyMosaic patternSystemic sclerosis/scleroderma

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Area of Science:

  • Rheumatology
  • Dermatology
  • Vascular Biology

Background:

  • Systemic sclerosis (SSc) is characterized by generalized microangiopathy.
  • Nailfold capillaroscopy is a key non-invasive tool for diagnosing SSc, included in recent EULAR/ACR classification criteria.
  • Endothelial damage in SSc capillaries can vary across different body compartments.

Observation:

  • A 67-year-old woman with limited cutaneous SSc presented with Raynaud's phenomenon.
  • Capillaroscopy revealed a "mosaic" pattern, combining normal, early, and active scleroderma-type findings.
  • The "mosaic" pattern included giant capillaries, hemorrhages, and disturbed capillary distribution.

Findings:

  • The observed "mosaic" pattern demonstrates the coexistence of different stages of microvascular damage in SSc.
  • This pattern underscores the heterogeneity of capillaroscopic findings within the same patient.
  • The findings emphasize the diagnostic value of nailfold capillaroscopy in SSc.

Implications:

  • Clinicians should perform bilateral nailfold capillaroscopy on all eight fingers to maximize diagnostic accuracy for SSc.
  • Detecting diverse microvascular changes, even within a "mosaic" pattern, is essential for comprehensive SSc evaluation.
  • This approach aids in the precise diagnosis and management of SSc-related microangiopathy.