Tongue Telangiectasias in Systemic Sclerosis
A 61-year-old woman with primary biliary cholangitis and a 1-year history of Raynaud’s phenomenon was referred to the rheumatology clinic for further evaluation and treatment. She reported a long-standing history of swollen fingers but no finger ulcerations, joint pain or swelling, dyspnea on exertion, dysphagia, or heartburn. On physical examination, telangiectasias were seen on the palms and the volar aspect of the fingers and on the tongue. There was no tightening of the perioral skin. The fingers were puffy and without sclerodactyly. Punctate hemorrhages of the nailfold capillaries were also noted, and a subsequent nailfold capillaroscopy confirmed capillary enlargement with pericapillary hemorrhage. The patient tested positive for anticentromere antibodies and negative for autoantibodies against topoisomerase I. A diagnosis of limited cutaneous systemic sclerosis was made. In systemic sclerosis, telangiectasias may be seen on the oral mucosa, as well as on the hands, face, and upper torso. Given this, an oral examination is an important part of the assessment. On further evaluation of this patient, no pulmonary hypertension or interstitial lung disease was noted. Treatment for symptoms of Raynaud’s phenomenon was initiated. At a 3-year follow-up, the symptoms of Raynaud’s phenomenon had abated but the patient’s telangiectasias remained.