CASE PRESENTATION: A 57 year old Caucasian male with a 20 year history of Thromboangitis obliterans (TO) presented primarily with fatigue and melena. He had a history of digit amputations for TO. Examination revealed regular tachycardia, basilar crackles, digit amputations and ulcerations, sclerodactyly and telangiectasias. Pan-endoscopy showed gastric arteriovenous malformations, watermelon stomach and was complicated by paroxysmal atrial flutter. Echocardiogram revealed preserved ejection fraction, reduced right ventricular function with increased size and right ventricle systolic pressure of 46 mm Hg. Further history revealed long standing Raynaud’s phenomenon, exertional dyspnea and progressive facial skin tightening. A chest CT showed sub-pleural interstitial thickening and fibrosis, consistent with usual interstitial pneumonia (UIP) pattern, in addition to bilateral pleural effusions (Fig.1 ). Serology revealed high titers of RNA polymerase III antibodies. Thus we challenged the diagnosis of TO and the patient was diagnosed with limited cutaneous SSc. Further evaluations are now ongoing.