• Vikas Marwah, Chandan Dev Singh Katoch, Arun Hegde, and Robin Choudhary.
• Department of Pulmonary, Critical Care, and Sleep Medicine, Army Institute of Cardiothoracic Sciences, Maharashtra, India.
• Chest. 2021 Feb 1; 159 (2): e93-e96.

Case PresentationA 54-year-old man who had worked in a cement factory for the past 30 years, presented to the chest clinic with complaints of insidious onset, gradually progressive breathlessness with intermittent dry cough of three years' duration. The symptoms were associated with bluish discoloration of fingers on exposure to cold. He also gave a history of digital ulcers at the fingertips of the same duration. These ulcers used to heal, leaving behind pitted scars. There was also an associated history of progressive tightening of skin involving the face, extremities, and trunk. He also complained of food getting stuck in the throat, and he had to take frequent sips of water while eating, along with a feeling of early satiety. There was also a history of skin pruritus. There was no history of arthritis, rash, or alopecia. He had been treated 15 years ago for pulmonary TB, with 9 months of anti-tubercular therapy. He denied any similar illness in the family. On eliciting his occupational history, he revealed that other coworkers in his workspace had complained of a similar illness. He was a nonsmoker and teetotaller with no known addictions or exposure to chemicals.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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