A 47-Year-Old Man Comes to the Physician with Skin Changes

A 47-year-old man comes to the physician with skin changes and joint pain.  He underwent human leukocyte antigen-matched allogeneic stem cell transplant for acute myeloid leukemia from his sister 1 year ago and was treated with methotrexate, sirolimus, and prednisone postoperatively.  Prednisone was tapered off and stopped 6 months ago.  Two months ago, he noticed progressively worsening skin changes.  He has difficulty using his fingers and complains of small joint pain.  He currently uses artificial tears for eye dryness and albuterol as needed for mild intermittent asthma.
Vital signs are within normal limits.  Skin examination shows extensive skin thickening with areas of hypopigmentation (Exhibit) .  The hand joints have limited mobility without redness or swelling.  The remainder of the examination is within normal limits.
Laboratory results are as follows:

Which of the following is the most likely diagnosis?

A) Eosinophilic fasciitis
B) Graft-versus-host disease
C) Nephrogenic systemic fibrosis
D) Systemic sclerosis

Correct Answer:

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