case_images: PMC8564069_01
case_images: Physical examination revealed the skin had turned shiny and tight. Severe sclerosis was detected on both pretibial regions (A). When touched, the skin felt rather sclerotic and lost the ability to fold compared to normal skin (B,C). Changes in the arm and lower abdomen in favor of morphea were also observed (D,E).
case_images: fmed-08-728411-g0001.jpg
case_images: PMC8564069_01_fmed-08-728411-g0001.jpg
case_images: F1
case_images: Physical examination revealed the skin had turned shiny and tight (Figure 1).
case_images: Thickening and hyalinization of connective tissue of deep dermis, subcutaneous fat and muscular fascia, and mucin deposition (A). Atrophy of adnexal structures, increased fibroblastsand dense collagens through the deep dermis (B). Infiltrative changes in the eccrine glands (C). No obvious eosinophilic infiltration was detected.
case_images: fmed-08-728411-g0002.jpg
case_images: PMC8564069_01_fmed-08-728411-g0002.jpg
case_images: F2
case_images: Therefore, a deep biopsy was performed on the left pre-tibial and left arm regions which showed changes in favor of sclerodermoid changes and no sign of eosinophilic fasciitis (Figure 2).
case_images: Timeline of events.
case_images: fmed-08-728411-g0003.jpg
case_images: PMC8564069_01_fmed-08-728411-g0003.jpg
case_images: F3
case_images: The timeline of events can be seen in Figure 3.