Atypical Presentation of Morphoea in an Elderly Male: Diagnostic Challenges in the Absence of Autoantibodies and Malignancy

Morphoea, or localized scleroderma, is a rare autoimmune connective tissue disorder distinguished by progressive dermal fibrosis and abnormal collagen deposition. While the condition most commonly affects children and middle-aged women, it can occasionally present in elderly individuals with atypical clinical features. Characteristic presentation includes well-defined plaques of thickened, indurated skin, often accompanied by skin discolouration, dryness, or loss of hair and sweat glands. This case describes the unusual presentation of morphoea in an 83-year-old male, whose systemic and cutaneous findings closely mimicked paraneoplastic and drug-induced syndromes. Comprehensive serological testing and malignancy screening yielded no evidence of underlying neoplastic or systemic autoimmune disorder. Definitive diagnosis was established through skin biopsy, which revealed histopathological features consistent with morphoea. This report highlights the importance of maintaining diagnostic vigilance, particularly in the elderly who may present without the expected serological markers or conventional risk factors. The case further highlights the essential role of histopathology in confirming morphoea and differentiating it from other mimicking conditions. Recognition of diverse clinical presentations remains vital for accurate diagnosis and timely management across all age groups.