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Anticentromere-Positive Systemic Sclerosis with Inter-Digit Pattern Heterogeneity

Name: Anticentromere-Positive Systemic Sclerosis with Inter-Digit Pattern Heterogeneity
Creator: Miguel Antonio Mesa Navas

Systemic Sclerosis (Anticentromere-Positive)Heterogeneous Scleroderma Pattern (Active to Late)Moderate to Severe

A 61-year-old Latin American woman with long-standing Raynaud phenomenon and recently diagnosed anticentromere-positive systemic sclerosis, showing markedly different capillaroscopic patterns across digits.

AuthorMiguel Antonio Mesa Navas

Clinical context

The patient is a 61-year-old Latin American woman, a non-smoker with no reported comorbidities, who has had Raynaud phenomenon since 2012 and was recently diagnosed with systemic sclerosis. Laboratory testing showed an ANA titer of 1:640 with a centromere pattern; anti-dsDNA, anti-Ro, anti-La, anti-Sm, and anti-RNP antibodies were negative. She was receiving no treatment at the time of the study.

Capillaroscopy

The study is notable for pronounced inter-digit and inter-field heterogeneity. L4C shows marked capillary loss (desertification), whereas L4A has relatively preserved, normal-appearing architecture. R2C and L3D show giant capillaries within a disorganized architecture. R4A demonstrates late-stage revascularization or neoangiogenesis—a morphology the contributor describes as a "post-late" pattern—while R5A shows transitional active-to-late features. The complete study is classified as a late scleroderma pattern, with a mean capillary density of 5.63/mm, enlarged capillaries in 43.5%, and giant capillaries in 2.5%. Image quality is variable; several fields are technically limited and should not be interpreted in isolation.

Key Capillaroscopic Findings

Marked inter-digit heterogeneity, emphasizing the need to examine all fingers
Capillary desertification in L4C, with relatively preserved architecture in L4A
Disorganized giant capillaries in R2C and L3D
Late neoangiogenic changes in R4A and active-to-late transitional features in R5A
Variable image quality, with some fields of limited interpretive value

Anticentromere-Positive Systemic Sclerosis with Inter-Digit Pattern Heterogeneity