Background: Scleredema adultorum of Buschke is an uncommon skin condition that may accompany following diabetes mellitus, proceeding of infection or may be associated with monoclonal gammopathy,. Our case had it with multiple other underlying causes. Observation: This is report of a case with scleredema of Buschke with history of eight months. The patient had no history of a definite diabetes mellitus, but only an impaired glucose tolerance test. Hyper IgG gammopathy with increasing of ASO titer in association with a history of preceding chronic infection of both legs following accidental fractures since of two years ago were seen also. Histological findings of a biopsy specimen from involved neck skin showed marked thickening of the reticular dermis and collagen fibers has been broaden and separated by clear spaces which showed positive reaction with alcian blue. Anti streptolysin O titer in his serum level was more than 1000 UI/ml (international union / per milliliter). Glucose tolerance test (2 hours after oral eating 70 gram anhydrous glucose powder) showed impaired (>200mg/dL) in three times doing exam, but glycosylated hemoglobin A-1c was as 4.5 as in goal limitation (action suggested >6.4). Results: Therapeutic plan included oral penicillin and cyclosporine and azathioprin that were not significantly effective during the last 7 months, but the patient feels mild improvement in the last month. Conclusion: This is an uncommon case of progressive scleredema adultorum of Buschke in a man with multiple underlying causes with mild impaired glucose tolerance test, increased G type of immunoglobulin (IgG) of 1942 mg/dl (normal range =700-1600mg/dl), and increased serum level of ASO titer, as well as history of chronic over imposing infections on both leg fractures and after operations.