Severe scleroderma colopathy at initial diagnosis of systemic sclerosis in a young man: a case report

Scleroderma, or systemic sclerosis (SSc) usually affects the gastrointestinal (GI) tract (up to ~90%), but severe lower GI dysmotility and intestinal pseudo- obstruction are uncommon, occurring in approximately 5. 4% of patients with SSc. We report a 25-year-old Palestinian male with a three- year history of profound unintentional weight loss (67 kg) and an eight- month history of postprandial diffuse abdominal pain, bloating, vomiting, diarrhea, and loss of appetite. Examination revealed cachexia, digital ulcers, and generalized skin thickening with hyperpigmentation. Inflammatory markers were elevated (CRP/ESR) with positive antinuclear antibody. Upper endoscopy demonstrated severe reflux esophagitis extending to the upper esophagus and mild erosive gastritis of the antrum. Colonoscopy revealed marked colonic hypomotility with minimal peristalsis and retained fecal matter. The patient was treated with mycophenolate mofetil beside symptomatic and supportive therapy (rifaximin, hyoscine butylbromide, and metoclopramide), with clinical improvement on follow-up. This case highlights severe SSc- related lower- GI dysmotility in a young male with extreme weight loss and chronic GI symptoms. Clinicians should consider SSc in patients with unexplained dysmotility/pseudo-obstruction features, especially when associated with Raynaud- spectrum vascular features, skin thickening, or positive ANA to reduce diagnostic delay and prevent further consequences, such as malnutrition.