Chris is aged 56 when she first presents with exertional dyspnoea — no fever, chest pain, cough or sputum.
She has had SLE for 12 years, manifesting with photosensitivity, hair loss, polyarthritis, prior pleurisy and neutropenia. There is no renal involvement.
Past medical history included an episode of superficial thrombophlebitis and an unexplained convulsion.
Brain MRI is normal. High lupus anticoagulant and strongly positive IgM, IgG and IgG-beta-2-glycoprotein 1 anticardiolipin antibodies are found. She declines