A 27-Year-Old Woman With Rapidly Progressive Shortness of Breath and Severe Alopecia

A 27-year-old previously healthy woman with no known exposure history presented with a 20-day history of progressively worsening breathlessness. She progressed from being breathless while hurrying on level ground to becoming breathless at rest and unable to complete sentences within 2 days. She reported multiple episodes of hemoptysis (approximately 30 mL daily) over the past 6 to 7 days, along with generalized weakness and fatigue for the last 7 days, and sudden onset of hair loss for the past 2 days. She reported episodic bluish discoloration of fingers on exposure to cold for the last 3 years but denied history of joint pain or skin rash.