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Systemic sclerosis-associated ILD — SCE Respiratory MCQ

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HardILDSystemic sclerosis-associated ILDSCE Respiratory

A 59-year-old woman with systemic sclerosis has worsening breathlessness. HRCT shows bilateral lower-zone ground-glass opacity with fine reticulation and traction bronchiectasis but no honeycombing. FVC has fallen from 82% to 68% predicted in 12 months and TLCO is 41% predicted. What is the most likely diagnosis?

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Correct answer: D — Systemic-sclerosis associated nonspecific interstitial pneumonia

Systemic sclerosis commonly causes CTD-ILD with an NSIP pattern, and the falling FVC indicates clinically significant progression. IPF is less likely in a patient with a defined connective tissue disease and HRCT lacking classic honeycombing. The other options do not fit the lower-zone NSIP pattern and systemic sclerosis context.

Reference: ERS/EULAR CTD-ILD guidance; NICE nintedanib for systemic sclerosis ILD