• Casal MouraMartaMDivision of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN., Eunhee S Yi, Matthew J Koster, Jay H Ryu, and Misbah Baqir.
• Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
• Chest. 2023 May 1; 163 (5): e207e210e207-e210.

AbstractA 79-year-old man was examined because of recurrent dyspnea and constitutional symptoms that included malaise, fatigue, fevers, and arthralgias over the past 7 years. He was a nonsmoker who was a retired farmer. Elevated levels of acute phase reactants and C-reactive protein and a high erythrocyte sedimentation rate were noted often in his health records. However, an extensive rheumatologic evaluation, which included serologic studies (antinuclear antibodies, cyclic citrullinated peptide antibodies, antineutrophil cytoplasmic antibodies) and temporal artery biopsy, had not shown an identifiable autoimmune disease. The patient had been treated intermittently with prednisone, with partial symptomatic improvement. Various cytopenias had been present over the preceding years; however, three bone marrow biopsy specimens showed moderately hypercellular bone marrow with no diagnostic findings.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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