A 29-year-old woman has had increasing weakness over the past year, and now has difficulty climbing a single flight of stairs. Her muscles are sore most of the time. She has little difficulty writing or typing, however. During the past 3 months, she has had increasing difficulty swallowing. She has experienced chest pain for the past week. On physical examination, she is afebrile. Her blood pressure is 115/75 mm Hg. Muscle strength is 4/5 in all extremities. No rashes are present. She has 2+ pitting edema to the knees. Rales are auscultated over lower lung fields. Laboratory studies show serum creatine kinase level of 458 U/L and Jo-1 antibodies. Which of the following additional complications of her disease is she most likely to have?
A 29-year-old woman has had increasing weakness over the past year, and now has difficulty climbing a single flight of stairs. Her muscles are sore most of the time. She has little difficulty writing or typing, however. During the past 3 months, she has had increasing difficulty swallowing. She has experienced chest pain for the past week. On physical examination, she is afebrile. Her blood pressure is 115/75 mm Hg. Muscle strength is 4/5 in all extremities. No rashes are present. She has 2+ pitting edema to the knees. Rales are auscultated over lower lung fields. Laboratory studies show serum creatine kinase level of 458 U/L and Jo-1 antibodies. Which of the following additional complications of her disease is she most likely to have?
💡 Explanation
**Core Concept**
The patient's symptoms and laboratory findings are consistent with polymyositis, an inflammatory muscle disease characterized by muscle weakness, soreness, and elevated serum creatine kinase levels. The presence of Jo-1 antibodies further supports this diagnosis, as these autoantibodies are commonly found in patients with polymyositis and dermatomyositis.
**Why the Correct Answer is Right**
The patient is most likely to have interstitial lung disease (ILD) as a complication of her disease. ILD is a common extramuscular manifestation of polymyositis, and the patient's symptoms of difficulty swallowing and chest pain, combined with the auscultation of rales over the lower lung fields, suggest pulmonary involvement. The presence of ILD can lead to progressive fibrosis and pulmonary function decline, which can be life-threatening.
**Why Each Wrong Option is Incorrect**
* **Option A:** Cardiac involvement is not a direct complication of polymyositis, although patients with dermatomyositis may have an increased risk of cardiac complications.
* **Option B:** Renal involvement is not a typical complication of polymyositis, and the patient's elevated creatinine levels are not mentioned in the case.
* **Option D:** Ocular involvement is not a direct complication of polymyositis, although patients with dermatomyositis may have an increased risk of ocular complications.
**Clinical Pearl / High-Yield Fact**
Polymyositis and dermatomyositis are both associated with an increased risk of ILD, and patients with these conditions should be closely monitored for pulmonary symptoms and signs.
**Correct Answer: C. Interstitial lung disease.**
✓ Correct Answer: B. Myocarditis
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