Trauma-Induced Unilateral Progression of Sclerosis in a Patient With Limited Cutaneous Systemic Sclerosis

Systemic sclerosis is an autoimmune connective tissue disease, which is characterized by immune dysregulation and progressive sclerosis of the skin with variable internal organ involvement. Exogenous triggers such as physical trauma are documented as a potential precipitating factor for systemic sclerosis; however, the condition typically presents with bilateral skin changes. Unilateral progression of systemic sclerosis is an extremely rare phenomenon, and the role injury and/or immobilization plays in provoking this presentation requires further elucidation. A 63-year-old female with an 11-year history of limited cutaneous systemic sclerosis presents with rapidly progressive sclerosis confined to her right hand and wrist following a radial fracture and six months of immobilization. Examination revealed increased swelling and stiffness, considerably decreased range of motion, and progressive sclerodactyly of all five digits. MRI, blood cultures, and venous ultrasound were unremarkable. A punch biopsy was performed, and the histologic findings were consistent with scleroderma. We report a unique case of unilateral progression of limited cutaneous systemic sclerosis after injury and immobilization, which highlights the potential role of trauma and immobilization in the pathogenesis of systemic sclerosis.