Paraneoplastic scleroderma: a patient with a history of breast cancer presenting with sclerodactyly and Raynaud’s phenomenon

A woman in her 70s with a past history of breast cancer in remission presented with several months of dyspnoea, skin tightness and Raynaud's phenomenon. Physical examination was significant for hypertension, hypoxaemia, sclerodactyly, diffuse crackles on auscultation and mild respiratory distress. Work-up revealed elevated serum creatinine, elevated right ventricular systolic pressure on echocardiography and nuclear bone scan findings of osseous metastatic disease. Captopril was initiated with concern for scleroderma renal crisis. The scleroderma panel was positive for RNA polymerase 11 and 155. Vertebral biopsy was diagnostic of recurrent breast cancer. Through multidisciplinary discussion, rituximab was initiated, and malignancy treatment was deferred; however, the patient developed several complications and ultimately elected to pursue inpatient hospice. In the setting of recurrent breast cancer, this case is suggestive of paraneoplastic scleroderma. The presence of underlying malignancy is an important consideration in new cases of scleroderma, and multidisciplinary management is key to determining treatment preference.