Active pattern on nailfold capillaroscopy in a patient with systemic sclerosis.

A 65-year-old man presented with a two-year history of Raynaud’s phenomenon (RP) and a ten-month history of rapidly progress of skin swelling and hardening. Autoantibody testing revealed positivity for antinuclear antibodies (1: 1000) and anti-Scl70 antibodies, baseline serum creatine and blood pressure were normal. Nailfold capillaroscopy (NC) examination demonstrated decreased capillary density, along with enlarged (giant) capillaries, perivascular effusion, hemor - rhage, and slowed blood flow (Figure 1A). Upon the diagno - sis of diffuse cutaneous systemic sclerosis (SSc), the patient sought care at a local hospital, where he initiated treatment with prednisone (30 mg/d). However, he returned to our institution two weeks later, due to the possibility of a scleroderma renal crisis with weakness, elevated blood pressure, chest distress, nausea and increased serum creatinine. The aberrant blood capillaries observed in patients with SSc (