New Onset Scleroderma in Elderly Males—A Case Series–Based Review of the Literature

Abstract

Scleroderma is an autoimmune disease traditionally affecting middle-aged females. Its occurrence in elderly males is uncommon and often associated with severe manifestations such as interstitial lung disease, cardiac involvement, and renal crises. This study aims to highlight the clinical features, diagnostic challenges, and outcomes of new-onset scleroderma in elderly males. In this case series–based review of new-onset scleroderma among elderly males, we describe the clinical manifestations and outcomes of 4 patients under our care, and review the epidemiology, clinical presentations, and prognosis of this specific group. The case series included 4 men aged 68 to 87 years. All patients presented with various atypical presentations and organ involvement. Laboratory tests revealed high titers of anti-nuclear antibodies in all patients. Either anti-RNA polymerase III or anti-SCL70 antibodies were positive in 3 patients, with the fourth positive with anti-Ro52 antibodies. Imaging and biopsies confirmed organ involvement in 3, with the fourth lost to follow-up. The time to diagnosis ranged from months to years. Two patients died from sudden cardiac death, reflecting a poor prognosis in this subpopulation. Classically, scleroderma is considered a disease affecting middle-aged women. In this case-based review, we highlight a rare and presumably underdiagnosed cohort of scleroderma patients. Multisystemic conditions usually attributed to old age may reflect clinical manifestations of scleroderma. This case series–based highlights what may be the tip of an iceberg regarding elderly males with scleroderma; the review underscores the necessity for heightened clinical vigilance and tailored management strategies for elderly males with suspected scleroderma.