Posters
Presenting Author Academic/Professional Position
Resident
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Faculty
Discipline/Specialty (Author 3)
Internal Medicine
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Introduction: Systemic sclerosis (SSc), commonly known as scleroderma, is a rare connective tissue disorder involving widespread fibrosis, immune system dysregulation, and vascular abnormalities1. The disease disproportionately affects women, with a female-to-male ratio of 4:1 to 9:1, and is marked by significant ethnic and healthcare disparities2. Underserved populations often experience worse outcomes, driven by higher medical costs and increased utilization of emergency and inpatient services3. Among Hispanic patients, language and cultural barriers further exacerbate disparities in access to and quality of care4. These challenges underscore the need for equitable healthcare strategies. We present the case of a young patient with SSc who faced severe disease complications due to limited access to healthcare and therapeutic interventions.
Case presentation: A 36-year-old Hispanic woman with a history of gastroesophageal reflux disease (GERD) and untreated scleroderma for the past year presented to the hospital with a two-week history of generalized abdominal pain, vomiting, and diarrhea. Vital signs were stable on admission. Physical examination revealed a patient with thickened skin, telangiectasias and loss of facial expression. She also had tightened hands with limited flexibility and pitting of the fingertips.
CT of the chest revealed ground-glass opacities in bilateral lungs consistent with early changes of scleroderma-related lung disease. An echocardiogram confirmed severe pulmonary hypertension with a right ventricular systolic pressure (RVSP) of 57 mmHg.
Immunologic workup was initially negative for scleroderma-specific antibodies. However, antinuclear antibodies (ANA) were positive and further testing showed positive anti-U1 ribonucleoprotein antibodies (Anti U1-RNP) antibodies, which are often associated with overlapping autoimmune conditions.
Upon further history-taking, the patient revealed that she had discontinued her immunosuppressive treatment with mycophenolate due to lack of medical insurance and she could not afford the cost out-of-pocket. This financial barrier significantly impacted her ability to manage her scleroderma and prevented appropriate disease-modifying treatment, contributing to the progression of her condition.
Discussion: Women with autoimmune diseases face significant financial challenges, including high disease burden, substantial out-of-pocket costs (OOP), difficulties maintaining work productivity, and potential employment disability.5 In the United States alone, women spend an estimated $15 billion more in OOP expenses than men. Even among those with insurance, over 30% report that their plans either fail to cover the full cost of their care or provide inadequate reimbursement.6 Undocumented Latino immigrants can face additional risks related to their legal status. They are not eligible for federally subsidized public health insurance, typically hold jobs that don’t provide health insurance and are unable to use safe net services due to fear of deportation, additionally they typically don’t benefit from legislative efforts to improve healthcare access due to financial limitations. 7 The average cost of treatment for SSc ranges from $44,454–$63,320 in patients that develop interstitial lung disease and pulmonary hypertension , underscoring the need for reforms to improve healthcare access for underserved populations with autoimmune conditions.8 In this patient with pulmonary hypertension and early changes of scleroderma lung disease by imaging, the cessation of treatment due to inaccessibility of insurance and financial hardship highlights the severity of progressive untreated autoimmune diseases such as SSc.
Recommended Citation
Aboytes, Jorge A.; Loayza, Jose J.; and Cantu, Ismael, "Health Inequities in an Undocumented Immigrant Woman with Scleroderma: A Case Report of Uninsured Care Challenges" (2025). Research Symposium. 79.
https://scholarworks.utrgv.edu/somrs/2025/posters/79
Included in
Health Inequities in an Undocumented Immigrant Woman with Scleroderma: A Case Report of Uninsured Care Challenges
Introduction: Systemic sclerosis (SSc), commonly known as scleroderma, is a rare connective tissue disorder involving widespread fibrosis, immune system dysregulation, and vascular abnormalities1. The disease disproportionately affects women, with a female-to-male ratio of 4:1 to 9:1, and is marked by significant ethnic and healthcare disparities2. Underserved populations often experience worse outcomes, driven by higher medical costs and increased utilization of emergency and inpatient services3. Among Hispanic patients, language and cultural barriers further exacerbate disparities in access to and quality of care4. These challenges underscore the need for equitable healthcare strategies. We present the case of a young patient with SSc who faced severe disease complications due to limited access to healthcare and therapeutic interventions.
Case presentation: A 36-year-old Hispanic woman with a history of gastroesophageal reflux disease (GERD) and untreated scleroderma for the past year presented to the hospital with a two-week history of generalized abdominal pain, vomiting, and diarrhea. Vital signs were stable on admission. Physical examination revealed a patient with thickened skin, telangiectasias and loss of facial expression. She also had tightened hands with limited flexibility and pitting of the fingertips.
CT of the chest revealed ground-glass opacities in bilateral lungs consistent with early changes of scleroderma-related lung disease. An echocardiogram confirmed severe pulmonary hypertension with a right ventricular systolic pressure (RVSP) of 57 mmHg.
Immunologic workup was initially negative for scleroderma-specific antibodies. However, antinuclear antibodies (ANA) were positive and further testing showed positive anti-U1 ribonucleoprotein antibodies (Anti U1-RNP) antibodies, which are often associated with overlapping autoimmune conditions.
Upon further history-taking, the patient revealed that she had discontinued her immunosuppressive treatment with mycophenolate due to lack of medical insurance and she could not afford the cost out-of-pocket. This financial barrier significantly impacted her ability to manage her scleroderma and prevented appropriate disease-modifying treatment, contributing to the progression of her condition.
Discussion: Women with autoimmune diseases face significant financial challenges, including high disease burden, substantial out-of-pocket costs (OOP), difficulties maintaining work productivity, and potential employment disability.5 In the United States alone, women spend an estimated $15 billion more in OOP expenses than men. Even among those with insurance, over 30% report that their plans either fail to cover the full cost of their care or provide inadequate reimbursement.6 Undocumented Latino immigrants can face additional risks related to their legal status. They are not eligible for federally subsidized public health insurance, typically hold jobs that don’t provide health insurance and are unable to use safe net services due to fear of deportation, additionally they typically don’t benefit from legislative efforts to improve healthcare access due to financial limitations. 7 The average cost of treatment for SSc ranges from $44,454–$63,320 in patients that develop interstitial lung disease and pulmonary hypertension , underscoring the need for reforms to improve healthcare access for underserved populations with autoimmune conditions.8 In this patient with pulmonary hypertension and early changes of scleroderma lung disease by imaging, the cessation of treatment due to inaccessibility of insurance and financial hardship highlights the severity of progressive untreated autoimmune diseases such as SSc.
