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A case of scleroderma presenting as cardiospasm (achalasia of the oesophagus).

Introduction Scleroderma is a systemic disease which involves the collagenous connective tissue of different organs in the body. The skin lesions are merely the external manifestations of this sytemic disease and are quite frequently the obvious features that lead to the diagnosis of the condition. Visceral changes however, can precede the skin manifestation (Rodnan & Fennell, 1962). The length of time for which this may be so is not generally recognized. For this reason the following case history is presented and shows that visceral charnges can be present for several years before skin changes are manifest. It also shows that involvement of the oesophagus presented as cardiospasm (achalasia) and was treated as such for years. The patient also illustrates the fact that vague abdominal symptoms simulating intestinal obstruction can be an early manifestation of the illness. Finally the case history confirms the statement that oesophageal involvement can be present in patients with Raynaud's phenomenon.