S&S: Hardening and tightening of patches of skin in a straight line or oval shape. The skin may be shinier due to the tightness. Based off of Maria's physical exam findings, her poor skin turgor and pale warm skin prove otherwise. The earliest signs would be exhibiting Raynaud's disease that responds to cold temperatures or emotional distress, which we are not aware of. In GI, the esophagus is affected due to dysphagia or heartburn. If intestines are affected, it would manifest into bloating, cramps, diarrhea, or constipation. Maria shows severe abdominal pain, diarrhea then constipation. If untreated, her kidneys, lungs, and hearts are the next target. CREST Syndrome which means calcinosis, Raynaud's phenomenon, esophageal dysmotility, scelerodactyly, and telangiectasia syndrome.
Labs/Diagnostics: Skin biopsy for antinuclear antibodies. Blood test for ANA (antipoisomerase-1-anti-sci-70) which appear in the blood of 40% of patients. Pulmonary spirometry, chest x-ray, ECG, echocardiogram, and 24- hour Holter monitoring. CT of lungs would show "honeycomb" or "ground glass" appearance due to pulmonary fibrosis development.
Treatment: None, but medications to control symptoms which includes NSAIDs, corticosteroids, and immunosuppressant agents.
