Do not dismiss interstitial lung abnormalities

Interstitial lung abnormalities (ILAs) are incidental findings on computed tomography (CT) scans in patients not suspected to have underlying interstitial lung disease (ILD). We report a case of a patient with ILAs who was subsequently diagnosed with lung cancer. We highlight the importance of following up on ILAs. We discuss about risk stratification, evaluation and uncertainties associated with ILAs. During evaluation, our patient tested positive for anti-melanoma differentiation-associated gene 5 (anti-MDA5). Anti-MDA5 is a myositis-specific antibody (MSA) associated with dermatomyositis (DM). Anti-MDA5 DM is a heterogeneous condition. We highlight the known clinical phenotypes of anti-MDA5 DM. As we discover more about anti-MDA5, we highlight the importance of interpreting a laboratory result in the appropriate clinical context before a diagnosis and treatment decision is made.