A 32 year-old woman is evaluated at a hospital for a 6 month history of worsening fatigue and 3 weeks of progressive shortness of breath. Over the past 2 weeks she has developed orthopnea and leg edema. Medical history is significant for diffuse cutaneous systemic sclerosis and gastroesophageal reflux disease. Her only medication is omeprazole.
On physical examination, the patient is alert but in respiratory distress. Temperature is 37.2 °C (99.0 °F), blood pressure is 110/78 mm Hg, pulse rate is 110/min, and respiration rate is 26/min. BMI is 30. Oxygen saturation is 93% on ambient air. An S3 and elevated jugular venous pressure are noted. Crackles are noted at the lung bases. Diffuse skin thickening of the face, anterior chest, arms stopping at the elbows, and legs is noted; there is sclerodactyly of the hands. There is lower extremity edema to the knees.
CBC and BMP normal except for a serum creatinine level of 2.3 mg/dL.
Chest radiograph shows bilateral pleural effusions and diffuse alveolar infiltrates. Echocardiogram shows generalized myocardial hypokinesis with a left ventricular ejection fraction of 25%. Electrocardiogram shows nonspecific T-wave changes.
Which of the following is the most likely cause of this patient's clinical presentation?
A. Pericarditis
B. Cardiomyopathy
C. Scleroderma Renal Crisis
D. Pulmonary Hypertion
E. None of the above