March 2025 Pulmonary Case of the Month: Interstitial Lung Disease of Uncertain Cause

Saturday, March 1, 2025 at 8:00AM
Rick Robbins, M.D. in CT scan, Cosentyx, histology, interstitial lung disease, lung biopsy, psoriasis, pulmonary function test, restrictive lung disease, rheumatoid factor, seckinumab

Lewis J. Wesselius MD¹

Clinton E. Jokerst MD²

Yasmeen M. Butt MD³

¹Pulmonary, ²Radiology2, and ³Pathology Departments

Mayo Clinic Arizona

Phoenix, AZ USA

Editor’s Note: Portions of this case were previously published in the Southwest Journal of Pulmonary, Critical Care & Sleep as the January 2025 Medical Image of the Month.

History of Present Illness

A 58-year-old man complained of gradually increasing shortness of breath. He denied any cough. An outside chest x-ray is reported as showing mild bilateral interstitial changes.

Past Medical History, Social History, and Family History

• He has a history of rheumatoid arthritis and has complaints of mild joint stiffness and soreness. He has taken mycophenolate for several years which has made no difference in his symptoms.
• He has never smoked and denies any occupational exposure.
• There is no family history of lung disease.

Physical Examination

• Vital Signs: SpO2 95% on room air but declined to 88% with ambulation.
• Chest: A few scattered inspiratory crackles noted.
• Cardiovascular: Regular rhythm without murmur.
• Extremities: No clubbing or edema. No evidence of synovitis or joint inflammation
• Skin: Slightly raised, pink, scaly lesions on elbows and knees.

Which of the following are indicated? (Click on the correct answer to be directed to the second of six pages)

1. Dermatology consult
2. Pulmonary function testing
3. Connective tissue disease panel
4. Thoracic CT scan
5. All of the above

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).