Abstract
BACKGROUND: Systemic sclerosis (SSc) is an autoimmune disorder characterized by progressive fibrosis and vascular complications. Osteomyelitis is a rare but serious complication in patients with systemic sclerosis, particularly those with advanced vascular compromise. This case is notable for the rapid progression of osteomyelitis and highlights the importance of early intervention and thorough clinical monitoring. CASE PRESENTATION: We report the case of a 68-year-old female with SSc (Scl-70 positive), treated with iloprost IV, nifedipine, bosentan, prednisone, and mycophenolate for pulmonary involvement. In January 2024, she developed acrocyanosis and severe pain in the fifth toe of the right foot. A small ulcer formed, and subsequent radiographic evaluation revealed rapid progression of osteolysis. Despite negative culture swabs, an infectious process was suspected, and combination antibiotic therapy was initiated. This treatment led to a gradual resolution of symptoms, with subsequent imaging showing detachment of the fifth toe. CONCLUSION: This case highlights the critical need for vigilant radiographic monitoring and timely antibiotic intervention in patients with SSc who develop vascular complications. Early diagnosis and treatment are crucial for optimizing patient outcomes and preventing severe bone damage.