A 48-year-old woman with diffuse cutaneous systemic sclerosis presents with progressive dyspnea and dry cough. High-resolution CT chest shows bilateral basilar honeycombing. Pulmonary function tests reveal a reduced DLCO and restrictive pattern. Anti-Scl-70 antibody is positive. What is the most likely pulmonary complication?
- A Pulmonary arterial hypertension
- B Recurrent aspiration pneumonia
- C Interstitial lung disease ✓
- D Pneumothorax
Correct answer: C. Interstitial lung disease
Explanation
Anti-Scl-70 (anti-topoisomerase I) is strongly associated with diffuse cutaneous systemic sclerosis and interstitial lung disease. The HRCT honeycombing and restrictive pattern confirm fibrosis. Pulmonary arterial hypertension is more linked to limited disease and anti-centromere antibodies. Aspiration pneumonia and pneumothorax are not typical primary complications.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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