Band Acro-Osteolysis as a Less Common Radiologic Pattern in Systemic Scleroderma: A Case Report

Acro-osteolysis is a less common radiological condition characterized by resorption of the distal phalanges, presenting as terminal tuft or band-like resorption.

A 37-year-old female housekeeper with a 6-month history of progressive fingertip pain, swelling, dactylitis, and skin tightening affecting the upper limbs, face, and trunk, without Raynaud's phenomenon. Physical examination revealed sclerodermatous changes. Laboratory findings showed normal C-reactive protein, calcium, parathyroid hormone, and vitamin D levels, but positive anti-SSA antibody, suggesting an autoimmune etiology. Nailfold capillaroscopy indicated scleroderma with dilated capillary loops and avascular areas. Radiographs confirmed band acro-osteolysis in the first, second, and fifth digits bilaterally and the third digit of the left hand. A technetium-99m bone scan revealed increased radiotracer uptake in the affected digits. Whole-body imaging and serum protein electrophoresis ruled out malignancy. A deep skin biopsy confirmed systemic scleroderma with dermal fibrosis and collagen deposition. The patient was treated with prednisolone and mycophenolate mofetil, with close outpatient follow-up.

Our report is among the few reported cases of "band acro-osteolysis" without Raynaud's phenomenon in systemic scleroderma. This case highlights an atypical presentation of systemic scleroderma with band acro-osteolysis and dactylitis, emphasizing the importance of recognizing uncommon manifestations for early diagnosis and intervention. The multifactorial pathogenesis, involving vascular dysfunction and inflammation, underscores the need for personalized management to prevent complications.