Case: 62-year-old male with progressive shortness of breath over the past two years

Past Medical & Surgical History:

• 11 years prior orchiectomy for seminoma and radiation

Allergies: Penicillin

Medicines:

• Nifedipine
• Furosemide
• Statin

Family History: Negative for lung disease or rheumatologic processes

Social History: 30 pack-years cigarette consumption and stopped 15 years earlier

Travel History: Negative

Review of Systems:

• General: lost 15 pounds over the last year associated with decreased appetite
• HEENT: chronic sinusitis and multiple sinus surgeries in the past
• Heart: high blood pressure, hyperlipidemia
• Endocrine: hypothyroid

• General: well appearing
• Vital Signs:
• BP: 110/70
• Pulse: 85 RR
• 26 breaths/minute
• HEENT: No skin tightness around his mouth
• Neck: No jugular vein distention
• Cardiovascular System: No findings of pulmonary hypertension
• Respiratory System: Inspiratory crackles over lower half of chest
• Extremities: Fingers with few telangiectasias, mild skin tightening (sclerodactyly) of fingers; rheumatologist noted multiple capillary dilatations and some drop-out on capillaroscopy.
• Musculoskeletal System: no arthritis or synovitis

Laboratory Workup:
ANA positive 1:320, speckled pattern with a negative Sm antibody, negative Scl-70 antibody; an echocardiogram revealed an estimated pulmonary artery systolic pressure of 55 mmHg.

Initial PFT Data:

• FVC 2.9, 63% of predicted
•  DL_CO 9.9 mL/min/mmHg, 30% of predicted
•  DL_CO/TLC 2.6, 54% of predicted