ABSTRACT
A 69-year-old woman was referred to hospital by her general practitioner for assessment of painful lesions over her shins. The patient explained that she had suffered from lower limb venous ulceration for several years, but over the past 3–4 months she had noticed red patches on her shins, which were becoming increasingly inflamed and tender. She was now experiencing constant pain in her legs and her mobility was consequently becoming limited. She had been feeling short of breath for around 6 months and had experienced a dry cough for a similar duration of time. She had been referred to the chest clinic for investigation of her cough and was awaiting computed tomography (CT) imaging of her lungs. She reported unintentional weight loss of around 6 kg over 2 months. Her past medical history included hypertension, chronic obstructive pulmonary disease (COPD) and rheumatoid arthritis. She took regular 5 mg ramipril OD, 2.5 mg bisoprolol OD, 2.5 mg bendroflumethiazide OD, 20 mg methotrexate once weekly and 5 mg folic acid once weekly. She was a retired actress and lived with her husband and grandson. She was an ex-smoker with a 40 pack year history and drank around 10 units of alcohol per week.
