A 56-year-old woman was admitted because of the sudden onset of dyspnea and hypotension. At 16 years of age, she had received combination chemotherapy and extended-field radiation therapy for Hodgkin's lymphoma. On admission, an electrocardiogram showed an acute myocardial infarction. A stent was placed, but hypotension and acidosis persisted, and the patient died.

An 89-year-old man was admitted to the hospital because of progressive dyspnea for 6 months, worsening over the past 3 days. He had a history of exposure to asbestos and had smoked cigarettes for many years. Imaging studies revealed a pleural plaque and pulmonary interstitial fibrosis with superimposed ground-glass opacities. Hypoxemia and intermittent hypotension occurred. Despite oxygen supplementation, mechanical ventilation, and pressor administration, a cardiac arrest occurred, and the patient died on the eighth hospital day. An autopsy was performed.

A 27-year-old man was seen at this hospital because of progressive dyspnea and decreased exercise tolerance during the past 2 years. Imaging studies showed diffuse pulmonary fibrosis. The patient had lighter skin than many in his family, although he reported that several family members had light skin and respiratory problems. He had a history of easy bruising. On examination, his skin was pale, and there was clubbing of the fingers and toes, normal breath sounds, pigmented irises, and horizontal nystagmus. A diagnostic procedure was performed.

A 37-year-old woman had a 4-month history of episodes of vertigo, followed by tinnitus, decreased hearing in her right ear, and right facial weakness; on the day of admission, she had a generalized seizure. On admission, she was confused and combative and had garbled speech, a right facial droop, and generalized hyperreflexia. Magnetic resonance imaging of the brain and spinal cord revealed multifocal linear and nodular enhancement of the leptomeninges. A diagnostic procedure was performed.

A 46-year-old woman was seen by a rheumatology consultant because of stiffness of the joints and skin. She had been well until 7 years earlier, when an episode of group A streptococcal pneumonia complicated by septic shock left her with chronic kidney disease and a painful peripheral neuropathy. Three years later, gradually progressive stiffness of the skin of her hands and feet developed, with pain and stiffness of the joints; renal failure worsened, and respiratory distress and congestive heart failure developed. A diagnostic procedure was performed.