Q. A 49-year-old woman comes to the physician’s office for fatigue and worsening muscle weakness for the past 6 months. She finds it very difficult to climb stairs, rise from a sitting position, comb her hair, and reach for items in cabinets that are above her shoulders. For the past 10 days, she has also noticed a rash on her face, chest, and hands. The rash is itchy and photosensitive. She reached menopause a year ago and is taking multivitamin supplements regularly. Her temperature is 98.4°F (36.9°C), pulse is 88 beats per minute, BP is 120/70 mm of Hg and respiratory rate is 14/min. Physical examination shows violaceous macules and patches over the periorbital, midfacial, neck, chest, and upper back regions. Hands show symmetric violaceous scaly papules over bony prominences on the dorsal aspects of the metacarpophalangeal and interphalangeal joints. Neuromuscular examination shows proximal symmetrical weakness affecting deltoids, hip flexors, abductors, and extensors with retained DTR. Lab tests show her serum creatine kinase as 2600 U/L and the presence of anti-Jo-1 antibodies. For which of the following conditions is the patient at increased risk?