Gastric Antral Vascular Ectasia Preceding the Diagnosis of Limited Cutaneous Systemic Sclerosis

Systemic sclerosis is an autoimmune connective tissue disease that affects multiple organ systems, leading to diverse clinical presentations. Raynaud's phenomenon is one of the most common early manifestations, reflecting the underlying vasculopathy. In rare cases, vascular changes also involve internal organs, including the gastrointestinal tract. We present the case of a 79-year-old female who first presented in 2015 with recurrent iron-deficiency anaemia requiring multiple blood transfusions. Oesophago-gastro-duodenoscopy revealed features of "watermelon stomach," consistent with gastric antral vascular ectasia (GAVE). She underwent multiple sessions of argon plasma coagulation to control bleeding. Seven to eight years later, she developed classical features of systemic sclerosis, including sclerodactyly, worsening Raynaud's phenomenon, skin calcifications, and digital ulcerations. Autoimmune testing was positive for antinuclear antibodies, anti-Ro, and anti-centromere antibodies, confirming limited cutaneous systemic sclerosis. This case demonstrates the potential for GAVE to appear before other features of systemic sclerosis become clinically evident. Patients presenting with idiopathic or recurrent GAVE should be evaluated for underlying connective tissue disease, as timely recognition can influence monitoring, treatment, and long-term outcomes.