A 40-year-old man with a history of smoking was hospitalized for breathlessness, weakness, fever, and productive cough with rapid deterioration of respiratory conditions. He did not report any other symptoms and had been in good health until the last 3 weeks.
On physical examination, crackles were heard at the base of the lungs. A rough appearance of the hands was noted as well as eyelid oedema. The abdominal examination was normal. On admission, the patient had acute respiratory failure. Chest radiograph and echocardiogram were done. Increased muscle and liver enzyme values were noted.
Laboratory immunological tests revealed moderately increased anti-nuclear antigen antibodies (1/100), as well as positive anti-extractable nuclear antigen (anti-Jo-1 antibodies positive and anti-nucleosome Mi2 positive). Pulmonary function tests showed a restrictive pattern on spirometry with a total lung capacity of 48% of the predicted normal value.
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