To the Editor.—
Progressive systemic scleroderma is a generalized disease, but, in contrast with other collagenous diseases, it rarely involves the nervous system. Definite primary involvement has never been reported, to our knowledge. Most previously reported cases have been associated with nonspecific neurological symptoms secondary to hypertension or to uremia caused by sclerodermic involvement of the heart, lungs, or kidneys.1We report a case in which subacute combined degeneration following vitamin B12 deficiency caused by sclerodermic involvement of the small intestine could be an explanation for the neurological symptoms in scleroderma.
Report of a Case.
A 69-year-old woman with a history of crural skin changes and fever attacks of ten years' duration was admitted to the hospital in 1966 with a spastic paraparesis. On the lower part of the legs the epidermis was smooth, shiny, and atrophic, the dermis was sclerotic, and muscular atrophy was found. A skin