Paclitaxel-induced scleroderma: A scoping review of reported cases with an illustrative case from our center

Paclitaxel-induced scleroderma is a rare but increasingly recognized adverse effect of taxane chemotherapy. Most cases present with distal edema and cutaneous sclerosis, usually without disease-specific autoantibodies or visceral involvement. This study aimed to map all published cases of paclitaxel-induced scleroderma and present a unique case characterized by dual anticentromere (ACA) and anti-cyclic citrullinated peptide (ACPA) antibody positivity. A scoping review of English-language literature was performed in PubMed and Scopus up to May 2025 using the terms "paclitaxel" OR "taxane" AND "scleroderma" OR "systemic sclerosis. " Only human case reports or case series describing paclitaxel- or nab-paclitaxel-induced scleroderma were included. Data were extracted on demographics, cancer type, clinical features, serology, and outcomes, and summarized descriptively. Nineteen publications describing 21 patients were analyzed. Most patients were female (85.7%), with a mean age of 58.1 years. Cutaneous involvement was predominant, affecting both upper and lower extremities in 85.7% of cases. Raynaud's phenomenon occurred in 28.6%, and visceral involvement was uncommon (9.5% interstitial lung fibrosis; 9.5% scleroderma renal crisis). Autoantibody profiles were largely negative; antinuclear antibodies (ANA) positivity was seen in 33.3% and ACA in only one case. Nearly all patients improved after paclitaxel withdrawal, with corticosteroids and/or methotrexate used in refractory disease. The presented patient developed scleroderma-like changes with ACA and ACPA positivity-an unprecedented serologic finding-together with transient synovitis and Raynaud's phenomenon, confirming an immune-mediated overlap phenotype. Paclitaxel-induced scleroderma typically manifests as a reversible cutaneous fibrosing reaction distinct from idiopathic systemic sclerosis. However, rare cases with autoimmune serology suggest underlying immune activation in genetically predisposed individuals. The coexistence of ACA and ACPA positivity in the current case broadens the immunologic spectrum of taxane-induced scleroderma and highlights the need for further mechanistic and immunogenetic studies.