The dilemma: scleroderma renal crisis vs lupus nephritis in a patient with mixed connective tissue disorder

Figures & data

Figure 1. Bilateral soft tissue swelling of the hands with loss of skin crease and clubbing of the fingers

Figure 2. Chest X-ray above shows central vascular prominence with abnormal alveolar opacities in the mid and lower lungs bilaterally in addition to small effusions

Figure 3. High-resolution CT chest above showing diffuse ground-glass opacity in the lungs and bilateral pleural effusion

Table 1. Outlines the Kasukawa diagnostic criteria

Common symptoms	1. Raynaud phenomenon 2. Swollen fingers or hands
Antibodies to U1 RNP	1. Positive
Mixed findings	1. Systemic lupus erythematosus like findings Polyarthritis Lymphadenopathy Facial erythema Pericarditis or pleuritis Leukopenia or thrombocytopenia 2. Systemic sclerosis-like findings: Sclerodactyly Pulmonary fibrosis, restrictive pattern on pulmonary function tests, or reduced DLCO Hypomotility or esophageal dilation 3. Polymyositis-like symptoms: Muscle weakness Raised serum creatine kinase levels Myogenic pattern on electromyography

Figure 4. Reveals an occluded arteriole