Systemic Disease — Cutaneous and Ocular Manifestations

A 32-year-old woman from Delhi presents with a 3-month history of progressive dyspnea, dry cough, and arthralgias of the hands and knees. On examination, she has a malar rash sparing the nasolabial folds, oral ulcers, and photosensitivity. Fundoscopy reveals cotton-wool spots and retinal hemorrhages. Laboratory investigations show ANA 1:640 (homogeneous), anti-dsDNA antibodies positive, and low C3 and C4 levels. Urinalysis shows 2+ proteinuria and RBC casts. What is the most likely diagnosis?

A 28-year-old woman from Bangalore presents with a 6-week history of progressive vision loss in both eyes, described as 'floaters and blurred vision.' She also reports a 2-month history of erythematous nodules over the shins and a persistent dry cough. On examination, she has bilateral hilar lymphadenopathy on chest X-ray and anterior uveitis with granulomatous inflammation on slit-lamp examination. Serum calcium is elevated at 11.8 mg/dL, and ACE level is markedly elevated. What is the most likely diagnosis?

Which cutaneous manifestation of systemic sclerosis is characterized by thickening of skin and subcutaneous tissues with loss of normal skin appendages?

A 38-year-old woman from Mumbai presents with a 6-month history of progressive dyspnea, arthralgia affecting the knees and ankles, and a painless nodular rash over the shins and extensor surfaces of the forearms. On examination, she has bilateral hilar lymphadenopathy on chest X-ray and elevated serum calcium (11.8 mg/dL). Serum ACE level is elevated. Which ocular manifestation is she at highest risk of developing?

A 52-year-old man with a 10-year history of rheumatoid arthritis presents to the ophthalmology clinic with acute-onset left eye pain, photophobia, and blurred vision. On slit-lamp examination, he has a white, avascular infiltrate at the corneoscleral junction with surrounding hyperemia. Fundoscopy is unremarkable. What is the most likely diagnosis?