Scleroderma renal crisis precipitated because of delay in diagnosis

Summary: Systemic sclerosis (SSc) is a chronic autoimmune disease that can lead to life-threatening scleroderma renal crisis (SRC) in 2-15% of cases, and early treatment with ACE inhibitors is essential. This case involves a 61-year-old woman with swelling in her legs and feet, initially diagnosed with lymphedema. After positive tests for autoimmune markers, such as ANA and RNA polymerase III antibodies, and the development of high blood pressure and worsening kidney function, she was diagnosed with SSc and SRC. The patient’s symptoms included puffiness and sclerodactyly in her hands and legs, but the involvement of the feet and legs delayed the recognition of scleroderma. Steroid use in SSc patients can increase the risk of SRC, and early diagnosis and prompt treatment with ACE inhibitors are critical to managing the condition. This case highlights the importance of recognizing less common signs of SSc, such as skin changes in the feet and legs.