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Myositis-associated ILD — SCE Respiratory MCQ

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HardILDMyositis-associated ILDSCE Respiratory

A 51-year-old man with dermatomyositis is admitted with rapidly progressive dyspnoea. He has mechanic's hands, Raynaud's phenomenon and weakly positive anti-MDA5 antibody. HRCT shows diffuse ground-glass change and consolidation; PaO2 is 7.6 kPa on 35% oxygen. What is the most likely underlying cause?

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Correct answer: E — Rapidly progressive myositis-associated interstitial lung disease

Anti-MDA5 dermatomyositis is associated with rapidly progressive ILD, often presenting with severe hypoxaemia and diffuse CT change. Pulmonary oedema and alveolar haemorrhage are important differentials but are not supported by the myositis phenotype and antibody. Early recognition matters because urgent combined immunosuppression may be required.

Reference: ERS/EULAR CTD-ILD guidance; BTS ILD guidance