A 38-year-old man with no previous medical illness presented with 2-month history of dry cough and dyspnoea. There was no hemoptysis or fever. He was a non-smoker. Of note, he started to have burning sensation and rashes over his fingers for the past 6 months. Clinically, he was hypoxic and required high oxygen supplementation. Respiratory examination revealed fine crackles in both lung bases. Cutaneous assessment revealed palmar papules and digital ulcers in all his fingers. [Fig. 1, Panel A] There were also faint erythematous rashes around his eyelids.
