My long-standing patient with CRST syndrome (i.e., calcinosis cutis, Raynaud’s phenomenon, sclerodactyly and telangiectasia) had been losing ground over the past 18 months. BL was 54 and had developed restrictive pulmonary disease without radiographic pulmonary infiltrates. Her mean right heart pressures were moderately elevated by ultrasonography. But the greatest impact on her quality of life…
