Systemic Scleroderma. Presented by Dr. Carmen C. Thomas, and (by invitation) Dr. Charles Aaronson and Dr. Ralph Florence.
A Negro woman aged 36, well developed but emaciated, with masking of the facies, showed pronounced inability to open her mouth normally, or to employ fully the muscles of facial expression. There was general tightness of the integument, which markedly limited flexion of the fingers and the elbows. Reticulated hyper- and hypopigmentation was noted about the trunk. The finger pads were atrophic. Approximately 16 months ago, the patient became aware of progressive weakness, associated with loss of elasticity of the skin on the face, arms, and chest. There was gradual incapacitation due to arthralgia; dysphagia, accompanied by a 30-pound weight loss, has been of increasing severity. Hospitalization has been almost continuous since September, 1958.Medical examination disclosed pulmonary hypoventilation, and a grade II systolic murmur in the pulmonic area.