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Plaque morphea with neurological involvement—an extraordinary uncommon presentation

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Abstract

Localized scleroderma is traditionally considered to be limited to the skin, subcutaneous tissue, underlying bone, and in the craniofacial subtype, also nervous system involvement. However, recent studies have also described other systemic manifestations in these patients. Despite many reports of neurological involvement in patients with the craniofacial linear localized scleroderma, it is extremely rare in patients with the other subtypes of localized scleroderma. Here, we report an extraordinary case of localized scleroderma en plaque (classic morphea), located to the upper trunk and neck, associated with neurological manifestations presented as seizures. Magnetic resonance imaging of the brain showed focal lesions on the contralateral side to the skin involvement. This case is extremely relevant not only due to its rarity, but also because it supports the idea that the pathogenesis of the localized scleroderma is related to a systemic autoimmune process.

Key points

• Localized scleroderma is known to be related with systemic symptoms.

• To the best of our knowledge, this is the first case report of an exclusive plaque morphea with neurological involvement.

• This case provides support to the concept that the pathogenesis of the disease is a systemic autoimmune process.

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References

  1. Fett N, Werth VP (2011) Update on morphea: part I. Epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol 64(2):217–228

    Article  PubMed  Google Scholar 

  2. Zulian F, Vallongo C, Woo P, Russo R, Ruperto N, Harper J, Espada G, Corona F, Mukamel M, Vesely R et al (2005) Localized scleroderma in childhood is not just a skin disease. Arthritis Rheum 52(9):2873–2881

    Article  PubMed  Google Scholar 

  3. Peterson LS, Nelson AM, Su WP (1995) Classification of morphea (localized scleroderma). Mayo Clinic Proc Mayo Clinic 70(11):1068–1076

    Article  CAS  Google Scholar 

  4. Kreuter A (2012) Localized scleroderma. Dermatol Ther 25(2):135–147

    Article  PubMed  Google Scholar 

  5. Zulian F, Athreya BH, Laxer R, Nelson AM, de Feitosa Oliveira SK, Punaro MG, Cuttica R, Higgins GC, Van Suijlekom-Smit LW, Moore TL et al (2006) Juvenile localized scleroderma: clinical and epidemiological features in 750 children. An international study. Rheumatology 45(5):614–620

    Article  CAS  PubMed  Google Scholar 

  6. Amaral TN, Marques Neto JF, Lapa AT, Peres FA, Guirau CR, Appenzeller S (2012) Neurologic involvement in scleroderma en coup de sabre. Autoimmune Dis 2012:719685

    PubMed Central  PubMed  Google Scholar 

  7. Menni S, Marzano AV, Passoni E (1997) Neurologic abnormalities in two patients with facial hemiatrophy and sclerosis coexisting with morphea. Pediatr Dermatol 14(2):113–116

    Article  CAS  PubMed  Google Scholar 

  8. Kister I, Inglese M, Laxer RM, Herbert J (2008) Neurologic manifestations of localized scleroderma: a case report and literature review. Neurology 71(19):1538–1545

    Article  PubMed  Google Scholar 

  9. Unterberger I, Trinka E, Engelhardt K, Muigg A, Eller P, Wagner M, Sepp N, Bauer G (2003) Linear scleroderma "en coup de sabre" coexisting with plaque-morphea: neuroradiological manifestation and response to corticosteroids. J Neurol Neurosurg Psychiatry 74(5):661–664

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Katsumoto TR, Whitfield ML, Connolly MK (2011) The pathogenesis of systemic sclerosis. Ann Rev Pathol 6:509–537

    Article  CAS  Google Scholar 

  11. Falanga V, Medsger TA Jr, Reichlin M (1987) Antinuclear and anti-single-stranded DNA antibodies in morphea and generalized morphea. Arch Dermatol 123(3):350–353

    Article  CAS  PubMed  Google Scholar 

  12. Arkachaisri T, Fertig N, Pino S, Medsger TA Jr (2008) Serum autoantibodies and their clinical associations in patients with childhood- and adult-onset linear scleroderma. A single-center study. J Rheumatol 35(12):2439–2444

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Cristina Rosario.

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Rosario, C., Garelick, D., Greenberg, G. et al. Plaque morphea with neurological involvement—an extraordinary uncommon presentation. Clin Rheumatol 34, 597–601 (2015). https://doi.org/10.1007/s10067-013-2458-1

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  • DOI: https://doi.org/10.1007/s10067-013-2458-1

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