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Subsequent evaluation found generalized lymphadenopathy and an unexpected HIV infection diagnosis. Lymph node biopsy demonstrated reactive inflammatory changes linked to systemic sclerosis. The report underscores the need to assess coexisting infections in autoimmune disease and highlights the risk of profound vascular complications when scleroderma is not treated, especially in immunocompromised patients.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/gangrenous-digital-ischemia-unmasking-hiv-infection-in-untreated-systemic-sclerosis/407339/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/gangrenous-digital-ischemia-unmasking-hiv-infection-in-untreated-systemic-sclerosis/407339.png","ImageObject",300,407,{"name":92,"@type":93},"Levi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What condition did the patient have before presenting with gangrene?","Question",{"text":112,"@type":113},"She had systemic sclerosis with a five-year history and had remained untreated.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was HIV infection discovered in this case?",{"text":117,"@type":113},"Further investigation revealed generalized lymphadenopathy and an unexpected HIV infection, confirmed by HIV serology and Western blot.",{"name":119,"@type":110,"acceptedAnswer":120},"Why is this case clinically important?",{"text":121,"@type":113},"It emphasizes evaluating coexisting infections in autoimmune diseases and shows how untreated systemic sclerosis can lead to severe vascular complications, particularly in immunocompromised patients.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},407339,1791247872,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},7971461740909,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Review began 11/03/2025  \nReview ended 11/18/2025  \nPublished 11/30/2025  \n© Copyright 2025  \nSiavosh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98182  \nOpen Access Case Report  \nGangrenous Digital Ischemia Unmasking HIV Infection in Untreated Systemic Sclerosis  \nParto Siavosh 1, Jaafar Al-Sadiq Jaf 2, Alireza Hejrati 3, Parnasadat Hosseini Migoni 3, Ali Shbeeb 4  \n1. Hematology and Medical Oncology, Rasoul Akram Hospital, Tehran, IRN 2. Stroke, Stepping Hill Hospital, Stockport, GBR 3. Department of Internal Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, IRN 4. Department of Orthopedic Surgery, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, IRN  \nCorresponding author: Jaafar Al-Sadiq Jaf, [j.aljaff2011@gmail.com](j.aljaff2011@gmail.com)  \nAbstract  \nWe report the case of a 55-year-old woman with untreated systemic sclerosis who presented with severe digital ischemia and dry gangrene requiring toe amputation. Further investigation revealed generalised lymphadenopathy and an unexpected diagnosis of HIV infection. Lymph node biopsy revealed reactive inflammatory changes associated with systemic sclerosis.  \nThis case highlights the importance of evaluating coexisting infections in autoimmune diseases and the potential for severe vascular complications when scleroderma remains untreated, particularly in immunocompromised patients.  \nCategories: HIV/AIDS, Rheumatology, Orthopedics  \nKeywords: digital gangrene, hiv, ischemia, scleroderma, systemic sclerosis, vasculopathy  \nIntroduction  \nSystemic sclerosis (SSc) is a chronic autoimmune connective tissue disease characterised by immune dysregulation, vasculopathy, and progressive fibrosis affecting the skin and internal organs [1] . Vascular injury plays a central role in its clinical expression, manifesting most commonly as Raynaud phenomenon and digital ulceration. Digital gangrene, although recognised, represents the severe end of the vascular spectrum and is reported far less frequently, particularly when it progresses to amputation [2,3] .  \nAlthough survival of HIV-infected individuals has improved with antiretroviral therapy, the coexistence of HIV and systemic autoimmune conditions remains uncommon [4] . HIV may blunt classical inflammatory expression through profound CD4 lymphopenia, yet paradoxically may also intensify endothelial injury and accelerate tissue damage through chronic immune activation [4] . Published experience describing overlap between SSc and HIV remains limited, and atypical or fulminant manifestations are not well characterised in the literature [2] .  \nThis case describes a woman with longstanding untreated SSc who presented with extensive digital gangrene in the context of newly diagnosed advanced HIV infection. The degree of ischaemic destruction was striking and highlights how profound immunosuppression can alter disease trajectory. We present this case to emphasise awareness of this rare overlap, and the diagnostic and clinical implications when severe vascular complications occur in systemic sclerosis.  \nCase Presentation  \nA 55-year-old woman with a known five-year history of systemic sclerosis remained untreated (biopsy shown in Figure 1), reportedly due to financial constraints and lack of specialist access. She presented with progressive black discolouration of the fingers and toes, which evolved over several weeks from painful cyanosis to dry gangrene. She also noted increased facial skin tightening, which resulted in microstomia anda characteristic sclerodermoid appearance.  \nHow to cite this article  \nSiavosh P , Jaf J , Hejrati A, et al. (November 30 , 2025) Gangrenous Digital","cbCaiot9kpJW1beE","https://ap.wps.com/l/cbCaiot9kpJW1beE","pdf",6630137,"English","# Abstract\n# Introduction\n# Case Presentation\n## Physical Examination\n## Initial Laboratory and Imaging Investigations","[{\"question\":\"What condition did the patient have before presenting with gangrene?\",\"answer\":\"She had systemic sclerosis with a five-year history and had remained untreated.\"},{\"question\":\"How was HIV infection discovered in this case?\",\"answer\":\"Further investigation revealed generalized lymphadenopathy and an unexpected HIV infection, confirmed by HIV serology and Western blot.\"},{\"question\":\"Why is this case clinically important?\",\"answer\":\"It emphasizes evaluating coexisting infections in autoimmune diseases and shows how untreated systemic sclerosis can lead to severe vascular complications, particularly in immunocompromised patients.\"}]","Gangrenous Digital Ischemia Unmasking HIV Infection in Untreated Systemic Sclerosis | PDF",1790573161,25]