A 25-year-old Palestinian man presented with a three-year history of profound unintentional weight loss of 67 kg and an eight-month history of postprandial abdominal pain, bloating, vomiting, diarrhea, and loss of appetite. Examination revealed cachexia, finger ulcers, skin thickening with hyperpigmentation, elevated inflammatory markers (CRP/ESR), and a positive antinuclear antibody. Upper endoscopy showed severe reflux esophagitis into the upper esophagus and mild erosive gastritis of the antrum. Colonoscopy showed marked hypomotility of the colon with minimal peristalsis and retained fecal material. Systemic sclerosis (SSc) affects up to 90% of patients in the gastrointestinal tract, but severe lower tract dysmotility and intestinal pseudo-obstruction occur in approximately 5.4% of patients. The patient was treated with mycophenolate mofetil along with rifaximin, hyoscine butylbromide and metoclopramide, which resulted in clinical improvement. The case highlights the need to consider SSc in patients with unexplained dysmotility, especially with skin changes or a positive ANA.