Localized scleroderma in a type 1 diabetic patient: a case report

Mariam Mabrouk; Chedia Zouaoui; Kahena Jaber; Ines Bani; Bchir Najla; Annam Benchhida; Dorra Dorraelguiche; Haroun Ouertani

doi:10.1530/endoabs.110.EP395

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Endocrine Abstracts (2025) 110 EP395 | DOI: 10.1530/endoabs.110.EP395

ECEESPE2025 ePoster Presentations Diabetes and Insulin (245 abstracts)

Localized scleroderma in a type 1 diabetic patient: a case report

Mariam Mabrouk ¹ , Chedia Zouaoui ¹ , Kahena Jaber ² , Ines Bani ¹ , Bchir Najla ¹ , Annam Benchhida ¹ , Dorra Dorraelguiche ¹ & Haroun Ouertani ¹

Author affiliations

¹Military Hospital of Tunis, Endocrinology Department, Tunis, Tunisia; ²Military Hospital of Tunis, Dermatology Department, Tunis, Tunisia

JOINT970

Introduction: Morphea or localized scleroderma is a rare disease characterized by excessive collagen fiber production in the dermis, leading to the appearance of indurated subcutaneous areas. The association of systemic scleroderma and type 1 diabetes has been reported but not morphea. We report the case of a 16-year-old girl who consulted for diabetes type 1 with extensive lipodystrophic areas.

Observation: A 16-year-old girl presented to the Endocrinology Department for uncontrolled diabetes. Her medical history included an auto-immune hypothyroidism treated with 75 mg/day of levothyroxine. She has been diabetic since the age of 8, diagnosed following a biological screening due to a cardinal syndrome. Anti-GAD65, IAA, ICA and anti-ZNT8 antibodies were negative. She was treated with insulin analogs: insulin detemir and aspart. Initially, she developed large indurated subcutaneous areas and atrophic zones in insulin injection sites (abdomen, arms, and thighs), despite right injection techniques and rotation. Progressively, new indurated subcutaneous areas appeared outside of the injection sites. The diagnosis of morphea was suspected and confirmed by a skin biopsy showing a homogenized reticular dermis, with collagen bundles that were more or less thick and dense, and either horizontal or parallel to the surface. Dot sclerosis was negative. The patient was started on methotrexate at 12.5 mg/week, and an insulin pump was proposed to obtain a better control of diabetes with reduced the number of injections.

Conclusion: The identification of localized scleroderma in a patient initially thought to have lipodystrophy highlights the importance of considering rare and atypical diagnoses in patients with diabetes as they can have a significant impact on diabetic control.