Abstract

A 62-year-old male presented with a 10-day history of dyspnoea and ankle swelling. Investigations revealed a haemoglobin of 13.0 g/l, white cell count of 5.7 × 109/l and platelet count of 279 × 109/l. Eosinophils were mildly elevated at 3.9 × 109/l (normal range 0–0.5) and C-reactive protein (CRP) increased at 49 mg/l. Renal, liver, thyroid function tests, serum calcium, rheumatoid factor, complement levels (C3 and C4) and immunoglobulins A, G and M were normal. Smooth muscle antibodies were weakly positive. The patient had suffered asthma for the past 30 years and had recent onset seronegative arthritis. Medication comprised beclomethasone and salbutamol inhalers and aminophylline at 200 mg daily. No recent travel had occurred and only temperate climate regions had been visited. Parasitic infection or underlying malignancy was not evident. The pulse was 110 bpm with a ‘gallop’ rhythm. There was marked pitting oedema to the thighs, an elevated JVP and coarse crackles at both lung bases. Chest radiography showed a small right and larger left effusion with an …

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