A 29-year-old woman has had increasing weakness over the past year, and now has difficulty climbing a single flight of stairs. Her muscles are sore most of the time. She has little difficulty writing or typing, however. During the past 3 months, she has had increasing difficulty swallowing. She has experienced chest pain for the past week. On physical examination, she is afebrile. Her blood pressure is 115/75 mm Hg. Muscle strength is 4/5 in all extremities. No rashes are present. She has 2+ pitting edema to the knees. Rales are auscultated over lower lung fields. Laboratory studies show serum creatine kinase level of 458 U/L and Jo-1 antibodies. Which of the following additional complications of her disease is she most likely to have?

Muscle weakness in polymyositis tends to be symmetric, and proximal muscles are involved first. This condition differs from dermatomyositis in that there is no skin involvement, and polymyositis typically affects adults. On biopsy, the skeletal muscle shows infiltration by lymphocytes along with degeneration and regeneration of muscle fibers. The lymphocytes are cytotoxic CD8+ cells. Some patients may have myocarditis, vasculitis, or pneumonitis, but in contrast to dermatomyositis, the risk of cancer is equivocal. Bony ankylosis is a feature of progressive or recurrent joint inflammation with rheumatoid arthritis. Pericarditis is most likely to be a feature of systemic lupus erythematosus or diffuse systemic sclerosis. Sclerodactyly is a feature of scleroderma. When not extensive, it typically indicates limited scleroderma (CREST syndrome); when extensive, it indicates diffuse scleroderma, which has a poorer prognosis. Nongonococcal urethritis, conjunctivitis, and arthritis are seen with reactive arthritis. Xerophthalmia (usually with accompanying xerostomia) is seen in Sjogren syndrome.