A Rare Case of Juvenile Systemic Sclerosis With Concurrent Disseminated Tuberculosis: Diagnostic and Therapeutic Challenges

We present the case of a 13-year-old female diagnosed with juvenile systemic sclerosis, diffuse cutaneous subtype, along with active disseminated tuberculosis. This co-occurrence poses unique diagnostic and therapeutic challenges, particularly given the risk of tuberculosis exacerbation due to immunosuppressive therapy required for systemic sclerosis. The patient had signs/symptoms like progressive skin tightening and Raynaud's phenomenon; the diagnosis was confirmed by the presence of anti-Scl-70 antibodies. Concurrently, active disseminated tuberculosis was identified by a cartridge-based nucleic acid amplification test (CBNAAT) and supported by high-resolution computed tomography (HRCT) thorax and fine needle aspiration cytology (FNAC) of the submandibular lymph node. Treatment involved anti-tuberculosis therapy prior to initiating immunosuppression, ensuring a careful balance between managing autoimmunity and infection. The case emphasizes the importance of multidisciplinary collaboration and vigilant follow-up in managing complex autoimmune conditions coexisting with infectious diseases. Early diagnosis and an individualized approach were crucial to achieving clinical improvement in this adolescent pediatric patient.