Presentation of Case A 59-year-old woman was admitted to the hospital because of dyspnea. In her youth she had had multiple attacks of pneumonia. For many years she had been treated intermittently with iron because of anemia. Twenty years before admission a pruritic maculopapular rash developed on the upper extremities; it lasted for 10 years and was unrelieved by multiple local measures. Ten years before entry she began to experience dryness of the eyes and mouth. Five years later she entered another hospital because of pleuritic pain. Heparin was given, but she was discharged with no definite diagnosis and without.
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