A 49-Year-Old Woman Develops Thickened and Bound-Down Skin

A 49-year-old woman insidiously developed spotty depigmentation of the chest along with thickened and bound-down skin of the upper torso. In addition, all of her fingers were swollen and her facial skin became so tight that she had difficulty smiling. Facial skin did not contain telangiectatic mats, and no digital tip ulcers were found. Finally, she complained about difficulty swallowing and dyspnea on exertion. Laboratory evaluation disclosed the following abnormalities: albuminuria, positive antinuclear antibodies (ANA) test (titer 1:160, speckled pattern), and positive anti-topoisomerase 1 antibody (Scl-70) test. Mild interstitial pulmonary fibrosis was detected on chest radiograph and decreased esophageal motility on manometry.