CUTANEOUS SCLERODERMA DIAGNOSED DURING THE INVESTIGATION OF SECONDARY HYPERTENSION IN A YOUNG ADULT: A CASE REPORT IN PRIMARY CARE
Abstract
Arterial hypertension in young adults requires expanded etiologic investigation when it occurs in the absence of traditional cardiovascular risk factors, given the higher likelihood of secondary and systemic causes in this age group. Autoimmune diseases may present with vascular involvement and nonspecific early clinical manifestations, contributing to diagnostic delay when initial etiologic evaluation is not performed. We report the case of a previously healthy 21-year-old male patient who sought care in a primary care setting due to recurrent episodes of elevated blood pressure associated with retrosternal pain. During expanded clinical investigation, progressive chronic cutaneous lesions present for approximately three years were identified. Dermatological evaluation revealed hyperpigmented atrophic lesions associated with cutaneous nodules, and biopsy demonstrated dermal sclerosis with perivascular inflammatory infiltrate, consistent with fibrosing cutaneous dermatitis, supporting the diagnosis of localized cutaneous scleroderma. Systemic laboratory investigation did not reveal specific autoantibodies. Based on clinicopathological correlation, treatment with methotrexate was initiated, with multidisciplinary follow-up. This case demonstrates that blood pressure abnormalities in young adults associated with persistent cutaneous manifestations should prompt investigation beyond the cardiovascular system. Longitudinal follow-up enabled progressive diagnostic clarification and early therapeutic decision-making, reinforcing the role of Family and Community Medicine in the early identification of rare systemic diseases.
Author Biographies
Médico de Família e Comunidade. Docente do curso de Medicina da Universidade de Gurupi (UnirG) e preceptor clínico na UBS Waldir Lins. Mestrando em Saúde da Família pela Universidade Federal do Tocantins (ProfSaúde/UFT).
Médica de Família e Comunidade. Hansenologista. Possui pós-graduação lato sensu em Dermatologia (não especialista). Universidade de Gurupi (UnirG), Gurupi, Tocantins, Brasil.
Médico de Família e Comunidade. Pós-graduando em Endocrinologia. Universidade de Gurupi (UnirG), Gurupi, Tocantins, Brasil.
Médico de Família e Comunidade. Médico do Trabalho. Centro Universitário Tocantinense Presidente Antônio Carlos (UNITPAC), Araguaína, Tocantins, Brasil.
Acadêmico de Medicina. Universidade de Gurupi (UnirG), Gurupi, Tocantins, Brasil.
Acadêmico de Medicina. Universidade de Gurupi (UnirG), Gurupi, Tocantins, Brasil.
Acadêmico de Medicina. Universidade de Gurupi (UnirG), Gurupi, Tocantins, Brasil.
References
1. Braunwald E. Braunwald’s heart disease: a textbook of cardiovascular medicine. 12th ed. Philadelphia: Elsevier; 2022.
2. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, et al. Harrison’s principles of internal medicine. 21st ed. New York: McGraw-Hill; 2022.
3. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2023 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2023;44(38):3599-3726 DOI: https://doi.org/10.1093/eurheartj/ehad194
4. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA guideline for high blood pressure. Hypertension. 2018;71(6):e13-e115.
5. Kaplan NM. Kaplan’s clinical hypertension. 11th ed. Philadelphia: Wolters Kluwer; 2021.
6. Barroso WKS, Rodrigues CIS, Bortolotto LA, Mota-Gomes MA, Brandão AA, Feitosa ADM, et al. Diretriz brasileira de hipertensão arterial – 2024. Arq Bras Cardiol. 2025;124(1):e1-e120.
7. Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell JR, eds. Kelley and Firestein’s textbook of rheumatology. 11th ed. Philadelphia: Elsevier; 2020.
8. Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D, eds. Rook’s textbook of dermatology. 10th ed. Oxford: Wiley-Blackwell; 2022.
9. Batani VM, Barsotti S, Lepri G, Guiducci S, Bellando-Randone S, Matucci-Cerinic M. Early diagnosis and outcomes in systemic sclerosis. Autoimmun Rev. 2024;23(2):103300 DOI: https://doi.org/10.1016/j.autrev.2023.103300
10. Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia: Elsevier; 2018.
11. James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Andrews diseases of the skin. 14th ed. Philadelphia: Elsevier; 2023.
12. Starfield B. Primary care: balancing health needs, services and technology. New York: Oxford University Press; 2002.
13. Allanore Y, Simms R, Distler O, Trojanowska M, Pope J, Denton CP, et al. Systemic sclerosis. Nat Rev Dis Primers. 2015;1:15002 DOI: https://doi.org/10.1038/nrdp.2015.2
14. World Health Organization. Global report on hypertension. Geneva: World Health Organization; 2021.
15. Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al. New creatinine- and cystatin C–based equations to estimate GFR without race. N Engl J Med. 2021;385(19):1737-49 DOI: https://doi.org/10.1056/NEJMoa2102953
16. Khan SS, Matsushita K, Sang Y, Ballew SH, Carson AP, Chang AR, et al. Development and validation of the PREVENT equations for cardiovascular disease risk prediction in the United States. Circulation. 2023;147(19):1441-53 DOI: https://doi.org/10.1161/CIRCULATIONAHA.122.061879
17. Denton CP, Khanna D. Systemic sclerosis. Lancet. 2017;390(10103):1685-99.
18. Kalil J. Imunologia clínica aplicada. São Paulo: Atheneu; 2022.
19. Brasil. Ministério da Saúde. Política Nacional de Atenção Básica. Brasília: Ministério da Saúde; 2017.
20. Organização Pan-Americana da Saúde. Atenção primária à saúde. Washington (DC): OPAS; 2023.
21. Virginio D, Camargo YK, Braga PC, Silva TAP. Atendimento de paciente idosa com crise hipertensiva: uma experiência na aplicação dos atributos nucleares da APS. RECIMA21. 2025;6(9):e696787 DOI: https://doi.org/10.47820/recima21.v6i9.6787
22. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775-9 DOI: https://doi.org/10.1001/jama.288.14.1775
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