The next case is a 56-year-old man who initially presented with weight loss, loin pain, haematuria and painful inflamed joints. He also complained of a persistent unproductive cough which had been worsening over the past three months. On further questioning, he revealed that he had felt a bit 'off-colour' for about a year, but had not felt that it was anything to bother his GP about; he had also developed a pronounced wheeze and some chest pain.

Previous medical history
Exertional angina and hypertension (diagnosed 8 years ago), and appendicitis (6 years ago).

Drug history
Thiazide diuretics - the patient had been taking these since his hypertension was diagnosed.

He was admitted to hospital, where a chest X-ray and blood samples were taken; the blood sample showed polycythaemia.

The patient's condition worsened over the next week, and he developed frank oedema which further impaired his breathing. Three days later, the patient arrested; rescusitation was unsucessful and the patient died.