Clinical case series

Doctors admitted this 45 year old woman into hospital with a six week history of arthralgia and night sweats and a painful rash over the anterior aspects of the ankles. She had no complaints of shortness of breath or cough. Neither had she travelled abroad recently.

On examination she had tender and swollen elbows, wrists, and ankles bilaterally. Her chest examination was unremarkable. The rash seen on examination is shown in fig 1.

Doctors did a number of blood tests on admission. One of these found angiotensin converting enzyme (ACE) at a concentration of 113 U/l (normal range 27-100 U/l).

Doctors also did a chest radiograph shown in fig 2.

Four months later at follow up she had symptomatically improved and her serum ACE level had fallen to 24 U/l.