Improvement of Microangiopathy in A Systemic Sclerosis Patient Following Hysterectomy for Leiomyoma: A Potential Role of Neoplasia.

Background: Systemic sclerosis (SSc) is a complex autoimmune disease characterised by vascular alterations, immune dysregulation and fibrosis. Microangiopathy is a hallmark of SSc and can be assessed non-invasively using nailfold videocapillaroscopy (NVC).

Case description: This is a case of a 50-year-old Caucasian woman with anticentromere-positive SSc, experiencing Raynaud's phenomenon and hand oedema. She met the 2013 ACR/EULAR classification criteria for SSc. Despite stable nifedipine therapy, her vasospastic episodes were only partially controlled. In March 2024, she underwent a total hysterectomy for a symptomatic uterine leiomyoma. Postoperatively, there was a marked improvement in Raynaud's phenomenon and NVC findings.

Discussion: This case suggests a potential link between neoplastic processes and exacerbation of SSc-related microangiopathy. It is hypothesised that tumour-derived factors, such as inflammatory cytokines and angiogenic mediators, may contribute to endothelial dysfunction and worsen vascular impairment. The observed microvascular improvement following tumour removal supports the hypothesis that neoplasms may act as disease-modifying factors in SSc. Further studies are needed to determine whether systematic malignancy screening in selected SSc patients may help identify modifiable triggers of microangiopathy.

Learning points: Observation of clinical and microvascular improvement in a systemic sclerosis patient is recommended following the removal of a uterine leiomyoma.The potential aggravating role of neoplastic processes in systemic sclerosis-associated microangiopathy.The importance of timely identification and management of neoplasms in systemic sclerosis patients to modulate disease progression.