Nodular scleroderma and pleomorphic acid-fast bacteria

This report describes a rare form of scleroderma associated with multiple, elevated, dermal nodules. In addition, rare acid-fast bacteria, and less rare non-acid-fast coccoid forms were seen in histologic sections from the nodules. Skin culture isolates in thioglycolate broth were positive for both intermittently acid-fast coccobacilli, as well as non-acid-fast cocci compatible with Staphylococcus epidermidis. These findings reconfirm the existence of pleomorphic, acid-fast bacteria in scleroderma. The possibility is discussed that these tissue and culture forms may be related to certain similar morphologic forms currently designated as "cell-wall-deficient L forms" or may be related to previously described unusual growth forms of mycobacteria. Further investigations for microbes both in skin culture and in histologic sections from patients with scleroderma may prove helpful in elucidating any possible role that bacteria might have in the pathogenesis of this disease.