Coexistence of sarcoidosis and systemic sclerosis with nailfold videocapillaroscopy documentation

Sarcoidosis and systemic sclerosis (SSc) are both rare multisystem disorders whose aetiology is not fully understood. Their coexistence is uncommon but clinically significant. Nailfold videocapillaroscopy (NVC) is a validated non-invasive technique for assessing peripheral microvascular involvement in SSc, and its potential utility in sarcoidosis/SSc overlap has not been systematically reported.

We report a 62-year-old female non-smoker with confirmed SSc (anti-Scl-70 positive, anti-Pm/Scl75 positive, sclerodactyly, Raynaud's phenomenon) and concurrent pulmonary sarcoidosis with hepatic involvement. At multidisciplinary reassessment, NVC revealed tortuous and crossed capillaries, rare inverted apex, rare giant capillaries, slowed flow, oedema, and sparse neoangiogenesis, in the absence of microhaemorrhages -- a mixed pattern compatible with sarcoidosis/SSc overlap and distinguishable from isolated SSc. Rheumatological assessment confirmed SSc in clinical stability; NT-proBNP had markedly improved from 1222 pg/ml to 148 pg/ml at the current reassessment (2.5 years later), indicating significant haemodynamic improvement under combined therapy. Chest HRCT was substantially unchanged.

This case illustrates the diagnostic value of NVC in characterizing microvascular involvement in sarcoidosis/SSc overlap. NVC can distinguish the overlap pattern from isolated SSc, support longitudinal disease monitoring, and contribute to the multidisciplinary management of this rare condition.