A Case Report of Mixed Connective Tissue Disease Presenting With Fever and Pruritus

Abstract

Autoimmune diseases are classified and diagnosed on the basis of clinical features. Joint pain, skin and mucosal ulceration, and skin thickening are among the most frequently seen features. Sometimes autoimmune diseases may mimic common clinical problems. The patient in this case report presented as a case of fever and pruritus, and in course of time, she was diagnosed to have multiple autoimmune tissue diseases. Moreover, these diseases did not show typical features. There were atypical presentations like ascites. There was diagnostic dilemma at first, and it sets an excellent example of this type of clinical problems that are unfamiliar to the clinicians in this part of the world. The objective of this article was to report a rare case of a 50-year-old Bengali female patient who presented initially with fever of undetermined cause and severe pruritus. This case was primarily confusing to have some eczematous skin condition, but later manifested all symptoms and signs of multiple autoimmune diseases, and was eventually diagnosed as a case of overlap syndrome. She manifested maculopapular rash, with ulcers, joint swellings, sclerodactyly in both hands, Gottron’s papules and ascites. Her antinuclear antibody (ANA) was positive in high titer and anti-smooth muscle antibody was positive. Her biopsy showed features of scleroderma. The patient was diagnosed to have systemic lupus erythematosus, scleroderma, and dermatomyositis. She was treated and recovered. This case report urges the clinicians to exercise great caution for connective tissue diseases. This rare case of disease is uncommon in the available literatures, especially for this ethnicity or region. This report should be of great interests to both diagnosticians of internal medicine and rheumatologists.




Clin Infect Immun. 2016;1(1):11-15
doi: http://dx.doi.org/10.14740/cii10w