MSFinals-2986

A 49-year-old woman complains of weakness and difficulty breathing. These symptoms have been getting worse over the last three months and have now become so severe that she is unable to work. She has no history of any medical conditions.

During the examination, the patient appears pale. The only notable finding is a strange involuntary movement of her fingers when she closes her eyes. Her blood film shows the presence of multi-lobed neutrophils.

What clinical feature might be observed in this patient?