73-year-old man presented to our institution with shortness of breath, diffuses myalgia and noticed the significant change of his hands. Physical examination was remarkable for bilateral crackle at lung base and rough, cracked skin at the tips and lateral aspects of the fingers “mechanic's hands” (Fig. 1A). Complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate and C-reactive protein were unremarkable. Computerized tomography of chest demonstrated small consolidations with peribronchovascular and peripheral subpleural and non-subpleural distribution, some with air bronchogram, and perilobular opacities (Fig.
