Presentation of Case First admission. A fifty-one-year-old woman was admitted to the hospital because of persistent diarrhea.Three years before admission, while the patient was working in an ice factory, there was the onset of Raynaud's phenomenon affecting the fingers, and a few months later she began to experience arthralgias of the elbows, wrists and knees, without swelling or deformity. A year and a half before entry she was admitted to another hospital because of pleurisy with a pleural effusion; several weeks thereafter she became dyspneic, cardiomegaly was observed, and congestive heart failure developed. With digitalis and diuretics the dyspnea . . .