A multisystem mystery as a patient deteriorates

An unusual diagnosis is revealed when a patient presents with progressive markers of inflammation and symptoms and signs affecting multiple systems.

Elaine, a 62-year-old female with a history of rheumatoid arthritis, hypertension and diabetes presents with progressive cough and shortness of breath over the preceding weeks.

The dyspnoea is more marked at night and on lying down. Elaine has been given two courses of oral antibiotics, with no effect.