Laboratory evaluation showed anemia (hemoglobin, 7.8 g/dL), leukopenia (WBC count, 2,580 k/μL), and microscopic hematuria and proteinuria. Inflammatory markers were elevated, with erythrocyte sedimentation rate of 85 mm/h and C-reactive protein level of 6.3 mg/dL. Serology showed a strongly positive antinuclear antibody of 12.7 (normal < 1.5 optical density ratio) and a markedly elevated anti-dsDNA (365 IU/mL). Antibodies against extractable nuclear antigens and myositis-specific antibodies were negative. Complement levels were normal (C3, 99 mg/dL; C4, 10 mg/dL). The chest radiograph and CT scan of the chest (Figs 1, 2) showed a small left pleural effusion and small lung volumes, with otherwise normal lung parenchyma. Pulmonary function tests (PFTs) (Table 1) revealed a restrictive ventilatory defect, with an FVC of 1.17 L in the sitting position (23% predicted), which decreased by 27% to 0.85 L in the supine position. The maximal inspiratory pressure and maximal expiratory pressure were 57% and 40% predicted, respectively. Evaluation of the diaphragms under fluoroscopy showed reduced downward excursion of both diaphragms, with the right diaphragm being the most impaired.