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A 49-year-old male asthmatic (on Montelukast) with multiple sclerosis presented with shortness of breath and generalised weakness. On examination, he was in cardiac failure with a systolic murmur, rapid atrial fibrillation and weakness in all four limbs with slurred speech. His white cell count was 37×109/L, eosinophils 25×109/L, urea 13.6 mmol/L, creatinine 131 μmol/L, troponin I 4448 ng/L, anti-neutrophil cytoplasmic antibodies (ANCA) weakly positive (negative myeloperoxidase (MPO) and proteinase 3 …
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