Ans. A: Hypogammaglobulinemia Manifestations of mixed connective-tissue disease (MCTD) can be variable. Most patients experience Raynaud phenomenon, ahralgia/ahritis, swollen hands, sclerodactyly or acrosclerosis, and mild myositis. The following may be revealed by history or physical examination: Raynaud phenomenon Ahralgia/ ahritis Esophageal hypomotility Pulmonary dysfunction Swollen hands Myositis Rash Leukopenia Sclerodactyly Pleuritis/ pericarditis Pulmonary hypeension Membranous glomerulonephritis Lab investigations shows features of inflammation with elevated ESR and hypergammaglobulinemia