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Some risks have been identified as potential triggers of scleroderma renal crisis, including the high-dose oral corticosteroids. Here, we present a patient who developed clinically severe systemic sclerosis and scleroderma renal crisis after exposure to oral corticosteroids and intravitreal vascular endothelial growth factor blockade with bevacizumab for cotton wool spots. The patient\u2019s scleroderma renal crisis was severe, progressive, and refractory to the standard of care therapy: oral captopril. Biopsy showed a diffuse thrombotic microangiopathy and findings consistent with scleroderma renal crisis. We hypothesize that depletion of systemic vascular endothelial growth factor with intravitreal anti\u2013vascular endothelial growth factor injections likely contributed to the particularly severe presentation seen in this case. Though the finding of a monoclonal gammopathy of undetermined significance is another complicating factor, this case suggests that vascular endothelial growth factor inhibition may be a newly recognized trigger of scleroderma renal crisis. <\/jats:p>","DOI":"10.1177\/2050313x20952650","type":"journal-article","created":{"date-parts":[[2020,8,21]],"date-time":"2020-08-21T11:51:14Z","timestamp":1598010674000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Refractory scleroderma renal crisis precipitated after high-dose oral corticosteroids and concurrent intravitreal injection of bevacizumab"],"prefix":"10.1177","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1807-8909","authenticated-orcid":false,"given":"Ramy M","family":"Hanna","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of California Irvine, Irvine, CA, USA"},{"name":"UC Irvine School of Medicine, Orange, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lama","family":"Abdelnour","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan E","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoney J","family":"Ferrey","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of California Irvine, Irvine, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Pai","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of California Irvine, Irvine, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kambiz","family":"Vahabzadeh","sequence":"additional","affiliation":[{"name":"Hoag Health System, Newport Beach, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of California Irvine, Irvine, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Everado A","family":"Torres","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California Irvine, Irvine, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamyar","family":"Kalantar-Zadeh","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of California Irvine, Irvine, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ira 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