Journal Information
Vol. 16. Issue 5. P2.
Pages 430 (September - October 2020)
Share
Share
Download PDF
More article options
Vol. 16. Issue 5. P2.
Pages 430 (September - October 2020)
Letter to the Editor
Full text access
Scleromyxedema: Presentation of 2 new cases and review of the literature
Escleromixedema, presentación de 2 nuevos casos y revisión de la literatura
Visits
3257
Eva M. Fonseca Aizpurua,
Corresponding author
evamfonseca@yahoo.es

Corresponding author.
, Carlos Delgado Vergesa, Esther González Garcíab, Luis Barcala Vázquezc
a Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
b Servicio de Hematología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
c Servicio de Dermatología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text
Dear Editor,

Scleromyxedema (SM) is a rare, progressive, chronic disease. Diagnosis is based on 4 criteria: (1) a papular sclerodermoid eruption; (2) microscopic evidence of mucin deposition, fibroblast proliferation and fibrosis; (3) monoclonal gammopathy and (4) absence of thyroid involvement. It may present with severe systemic participation, dermato-neuro syndrome may be fatal. Prognosis and treatment are unclear. At present favourable response has been described with intravenous immunoglobulins (IVIG) and haematopoietic stem cell transplant (HSCT).1–3

Our aim was to present 2 new cases and to review the patient series published in the medical literature – Pubmed, with SM diagnosis. A systematic search was made with the following terms: scleromyxedema (MeSH) AND paraproteinemias (MeSH).

Case 1: 37-year-old male, smoker for 10 years of one packet per day. He presented with oedema, erythema and induration in face, arms and hands of 6 months onset. Examination revealed: hard sclerodermiform skin with papular appearance, on the face, microstoma (with dysphagia and loss of 20kg in weight), and involved the pinna, chest, abdomen and arms with sclerodactyly, with a 31 classification score on the Rodnan scale. Analysis was performed with IgG lambda gammopathy. Treatment was prescribed with prednisone and hydroxychloroquine, with no improvement. Skin biopsy confirmed SM.

Case 2: 69-year-old male, with high blood pressure and dyslipidemia. The condition began with a papular eruption in the first finger of his right hand, left hand and face, and treatment was initiated with phototherapy, prednisone and hydroxychloroquine, with no improvement. There was a progression of the skin induration in his face, with microstoma (associated with dysphagia and loss of 7kg in weight), arms and hands with sclerodactyly, chest, abdomen and lower limbs, and classification of 26 on the Rodnan scale. Analysis was performed with IgG lambda gammopathy. A study of systemic involvement was conducted with diagnosis of sensory polyneuropathy in lower limbs and oesophageal hypomotility. Skin biopsy confirmed SM. In both cases treatment was initiated with IVIg, with partial response and he was referred to the haematological department for autologous stem cell transplant (ASCT), with improvement in skin symptoms, reduction of induration on the Rodnan scale and systemic improvement.

SM is a rare fibromucinosis-type skin disorder, described by Montgomery and Underwood in 1953. Classification was reviewed in 2001 by Rongioletti and Rebora. For its diagnosis, the patient has to have met with 4 criteria.1–3 It presents within an age range of 28–77 years, with no gender differences. As the disease advances, skin infiltration with sclerosis becomes generalised, leading to significant disability. The extra-cutaneous symptoms include: gastrointestinal dysmotility and peripheral neuropathy. Dermato-neuro syndrome describes the involvement of fever, convulsions and coma, which is an uncommon manifestation, and has a mortality rate of 32%4 SM is associated with a monoclonal protein and particularly with type IgG lambda. The relationship between skin findings and the paraprotein is unknown.2–4 Differential diagnosis has to be made with sclerodermia, and nephrogenic systemic fibrosis, among other diseases.5 Treatment of SM is unspecified.1 Up until now, a study by Blum et al. is the most extensive series of patients treated with IVIg and with favourable long-term follow-up results. However, response to immunoglobulins was transitory and required maintenance therapy.1 ASCT may be efficacious and efficient.2,3,6,7 IN 2001 Feasel et al. described the first case of remission of SM after an ASCT.6 In a later study in 2016, Chockalingam and Duvic concluded that ASCT appears to be a safe and effective long-term treatment.3

SM is a chronic disease with a reserved prognosis. There is no specific definitive treatment.8–10 Randomised, multicentre studies are needed, and larger patient groups.

Acknowledgements

Our thanks to Daniel González Fernández, Ana M. Pilar González Rodríguez and Pablo Gonzalvo Rodríguez.

References
[1]
M. Blum, F.M. Wigley, L.K. Hummers.
Scleromyxedema: a case series highlighting long-term outcomes of treatment with intravenous immunoglobulin (IVIG).
Medicine (Baltimore), 87 (2008), pp. 10-20
[2]
M.Q. Lacy, W.J. Hogan, M.A. Gertz, A. Dispenzieri, S.V. Rajkumar, S. Hayman, et al.
Successful treatment of scleromyxedema with autologous peripheral blood stem cell transplantation.
Arch Dermatol, 141 (2005), pp. 1277-1282
[3]
R. Chockalingam, M. Duvic.
Scleromyxedema: long-term follow-up after high-dose melphalan with autologous stem cell transplantation.
Int J Dermatol, 55 (2016), pp. e539-e543
[4]
K.E. Fleming, D. Virmani, E. Sutton, R. Langley, J. Corbin, S. Pasternak, et al.
Scleromyxedema and the dermato-neuro syndrome: case report and review of the literature.
J Cutan Pathol, 39 (2012), pp. 508-517
[5]
F. Wigley, R.P. Friday, J.A. Shepard, R.M. Nazarian.
Case records of the Massachusetts General Hospital. Case 8-2015. A 68-year-old man with multiple myeloma, skin tightness, arthralgias, and edema.
N Engl J Med, 372 (2015), pp. 1056-1067
[6]
A.M. Feasel, M.L. Donato, M. Duvic.
Complete remission of scleromyxedema following autologous stem cell transplantation.
Arch Dermatol, 137 (2001), pp. 1071-1072
[7]
M.L. Donato, A.M. Feasel, D.M. Weber, V.G. Prieto, S.A. Giralt, R.E. Champlin, et al.
Scleromyxedema: role of high-dose melphalan with autologous stem cell transplantation.
Blood, 107 (2006), pp. 463-466
[8]
A.M. Dinneen, C.H. Dicken.
Scleromyxedema.
J Am Acad Dermatol, 33 (1995), pp. 37-43
[9]
M. Le Moigne, J. Mazereeuw-Hautier, J.M. Bonnetblanc, L. Astudillo, M. D’Incan, D. Bessis, et al.
Clinical characteristics, outcome of scleromyxoedema: a retrospective multicentre study.
Ann Dermatol Venereol, 137 (2010), pp. 782-788
[10]
F. Rongioletti, G. Merlo, E. Cinotti, V. Fausti, E. Cozzani, B. Cribier, et al.
Scleromyxedema: a multicenter study of characteristics, comorbidities, course, and therapy in 30 patients.
Am Acad Dermatol, 69 (2013), pp. 66-72

Please cite this article as: Fonseca Aizpuru EM, Delgado Verges C, González García E, Barcala Vázquez L. Escleromixedema, presentación de 2 nuevos casos y revisión de la literatura. Reumatol Clin. 2020;16:430.

Copyright © 2018. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
Idiomas
Reumatología Clínica (English Edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?