Snapshot A 56-year-old man presents to his primary care physician with muscle weakness and joint contractures in his hands. He reports to having developed a painful rash that feels hard and states he has a general “tightness” in his body. He has a past medical history of type II diabetes mellitus and end-stage renal disease treated with hemodialysis. About 1 month prior to presentation, the patient had a transient ischemic attack and underwent an MRI with contrast of the brain. On physical exam, he has bilateral symmetric indurated papules and plaques on his forearms and shins, his hands have contractures, and his range of motion is limited in the involved joints. Laboratory evaluation reveals an elevated erythrocyte sedimentation rate, C-reactive protein, and ferritin. Introduction Clinical definition login to view 4 more bullets Epidemiology Incidence login to view 1 more bullet Demographics login to view 1 more bullet Risk factors login to view 4 more bullets Etiology Gadolinium login to view 1 more bullet Pathogenesis login to view 6 more bullets Presentation Symptoms login to view 10 more bullets Physical exam login to view 8 more bullets Imaging CT scan with contrast login to view 4 more bullets Studies Labs login to view 3 more bullets Biopsy reaching subcutaneous tissue login to view 1 more bullet Differential Scleroderma login to view 1 more bullet Treatment No medical intervention proven to be effective The following may have some benefit login to view 12 more bullets Complications Respiratory failure from lung involvement Wheelchair dependence due to immobility Prognosis 30% mortality Positive prognostic factors login to view 1 more bullet