A patient presents to your clinic with polyarthritis and ele | Figure 1

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Patient Case

A patient presents to your clinic with polyarthritis and elevated inflammatory markers. She has been diagnosed with rheumatoid arthritis and treated with hydroxychloroquine without significant benefit. An X-ray identifies early interstitial markings and she has interstitial lung disease on a CT.

Further history reveals cracking over her palms and peringual lesions. A myositis panel returns positive for a Jo-1 antibody at a high titer, confirming a diagnosis of anti-synthetase syndrome.

Diagnosis

antisynthetase syndrome

Imaging and Background

Background
People with connective tissue disease such as rheumatoid arthritis and systemic sclerosis may develop a group of lung diseases called interstitial lung disease. This can affect breathing and quality of life, and can lead to a reduced life span. A drug called cyclophosphamide has been useful in treating other illnesses, but it has side effects.

Key findings
There is some low-quality evidence showing small benefit of using cyclophosphamide compared with placebo in terms of lung function and symptoms of breathlessness. No clear evidence shows that people who took cyclophosphamide had better lung function than people who took a different drug (mycophenolate mofetil). Some people experienced low blood counts, blood in their urine, and nausea.
The trials mostly included people with systemic sclerosis, so these results may not apply to all people with interstitial lung disease with connective tissue disease.

Hand scales, She is a known rheumatoid arthritis patient, she has scales on head as well but no scales on extensor surfaces. Is it psoriasis or can it be something else?

26 year old, Nulligravid with Bilateral Interstitial Pneumonia with purpura enlarging on prolonged standing.. later will have sinuses. CRP normal.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family. Are there any features in this ECG that would warrant further work-up or is this just a pediatric ECG?