Coexistence of Ankylosing Spondylitis With Morphea: A Case Report

Abstract

Morphea, also known as localized scleroderma, is a chronic cutaneous disorder caused by excessive collagen deposition, and characterized by fat tissue atrophy and by thickening and hardening of the skin.1 Morphea can be seen in different shapes on the body and extremities, from small plaques to large lesions causing cosmetic problems. 1 Raynaud's phenomenon, joint involvement, sclerodactyly, and constitutional symptoms found in scleroderma are not present in morphea. Morphea is usually asymptomatic, and the development of lesions is typically insidious. Extracutaneous involvement is present in 20% of patients. Although known to be an autoimmune-based disorder, the pathogenesis of morphea is still unclear. Radiation therapy, chimerism, infection or vaccination, drugs, trauma, hormones and genetic factors are implicated in the etiology. It may be also associated with the use of drugs such as bleomycin, D-penicillamine, vitamin K1, and L-5-hydroxytryptophane plus carbidopa, and is occasionally found in association with other autoimmune diseases. 3,4 We present herein a case of ankylosing spondylitis (AS) who developed morphea and was followed up in our rheumatology outpatient clinic. CASE REPORTA 60-year-old woman was followed up in our outpatient clinic due to human leukocyte antigen (HLA) B27 + AS with axial involvement. Although she had back pain for 30 years, she was first diagnosed two years ago when admitted with Morphea, which is also known as localized scleroderma, is a disorder caused by excessive collagen deposition and characterized by the thickening and hardening of the skin. Unlike systemic sclerosis, morphea lacks features such as Raynaud phenomenon, joint involvement, sclerodactyly, and constitutional symptoms. It may be associated with drug use and is occasionally found together with other autoimmune diseases. In this article, we report a 60-year-old woman who was admitted to our outpatient clinic due to HLA B27 + ankylosing spondylitis with axial involvement and morphea. Her disease was able to be managed with exercise and non-steroidal antiinflammatory drugs, however, a 10¥7 cm diameter atrophic lesion of medium hardness was identified on her left shoulder. The histopathology of the lesion was compatible with morphea, and improved with topical steroid treatment. Although the concomitance of autoimmune diseases is frequent, there is no coexistence of morphea with ankylosing spondylitis in the literature, except a case who was considered to be associated with the adalimumab use. Despite limited data, however, common autoimmune pathogenesis may be seen in association with ankylosing spondylitis and morphea.