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The Groove Sign
Ana Serrano-Combarro1, Jenna Guma2, Sergio A Jimenez3
1Department of Medicine, Division of Rheumatology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States; Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
European Journal of Rheumatology
|August 6, 2026
Summary
This case study highlights a rare presentation of systemic sclerosis, characterized by rapid leg swelling, arthritis, and weight loss. The patient developed characteristic skin hardening and joint contractures, illustrating a unique diagnostic challenge.
Area of Science:
- Rheumatology
- Dermatology
- Internal Medicine
Background:
- Systemic sclerosis is a complex autoimmune disease affecting connective tissues.
- Early diagnosis is crucial for managing disease progression and improving patient outcomes.
- Atypical presentations can delay diagnosis and treatment.
Purpose of the Study:
- To describe a unique case of systemic sclerosis with unusual initial symptoms.
- To highlight the diagnostic challenges posed by this presentation.
- To emphasize the importance of recognizing subtle clinical signs.
Main Methods:
- A comprehensive clinical evaluation of a 74-year-old patient.
- Extensive laboratory and imaging workup, including bone marrow biopsy.
- Longitudinal observation of symptom development over several months.
Main Results:
- The patient presented with bilateral leg swelling, leukocytosis (monocytosis, eosinophilia), arthritis, elevated inflammatory markers, and significant weight loss.
- Malignancy was excluded through thorough investigation.
- Delayed evaluation revealed deep skin hardening and multiple joint contractures, indicative of systemic sclerosis.
Conclusions:
- This case underscores the diverse and sometimes atypical manifestations of systemic sclerosis.
- The "groove sign" in skin hardening may be an important diagnostic clue.
- Prompt recognition of subtle signs is vital for timely diagnosis and management of systemic sclerosis.
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