A 77-year-old woman with dyspnea and raynaud phenomenon.

A 77-year-old black woman who was a lifelong nonsmoker presented to our office for evaluation of worsening dyspnea over the last year that had severely limited her activities of daily living. Her medical history included type 2 diabetes, hypertension, and pacemaker placement. She reported paroxysmal nocturnal dyspnea and dry cough. She denied fevers, chills, chest pain, hemoptysis, or weight loss. She also reported whitening of her fingers with cold temperatures, suggestive of Raynaud phenomenon (RP). However, this symptom was not apparent on the initial visit, and she did not complain of it at that time.