Anti-RO 52-positive systemic sclerosis sine scleroderma with multisystem involvement and recurrent vasculitis

A 25‐year‐old lady presented to our hospital with recurrent asymptomatic eruption on upper limbs, chest and legs of 5 months duration. There was no history of fever, abdominal pain, joint pain and photosensitivity. She gave a history of developing pericardial effusion for which she underwent pericardiocentesis 1 year back. Cutaneous examination revealed pinchable skin on metacarpophalangeal joints. Multiple discrete depigmented atrophic shiny macules were distributed on both upper limbs, chest, upper back, knees and dorsa of feet. A few skin colored papules with central crusting were also noted among atrophic macules [Figures 1‐3]. The right index finger and middle finger showed dry gangrene with bluish discoloration [Figure 4]. A single, large, round punched‐out ulcer of 2 cm in diameter was present on the dorsum of the right foot, covered with necrotic slough [Figure 5]. Radial arterial pulsations on both sides were absent. A provisional diagnosis of vasculitis with peripheral vascular disease was made. Dego’s disease was considered as a differential diagnosis. Routine hematological and biochemical investigations were unremarkable. Antinuclear antibody, anti‐ds DNA, anti‐Scl 70 antibodies, anticentromere antibodies, anti‐polymerase III antibodies, U1 RNP antibodies, anticardiolipin antibodies, cytoplasmic antineutrophil cytoplasmic antibody and perinuclear anti‐neutrophil cytoplasmic antibody were negative. Anti‐RO52 antibodies were positive. Rheumatoid factor,