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A forty five years old school teacher who is a known case of rheumatoid arthritis for the last six years presents with generalized swelling of her body including face, abdomen and feet. She has been on various medications for rheumatoid arthritis in the past. However, on system review, she admits that she had been taking a new drug for the last six months for her rheumatoid arthritis prescribed by her old family physician. On examination she looks obviously pale and puffy in the face and generalized pitting edema of her body and feet. Laboratory results are given below;

Hemoglobin: 12mg%

Total Leukocyte count (TLC) and Differential leukocyte count (DLC): Normal

Blood urea: 40 mg%

Blood creatinine level: 1.2 mg%

Urine analysis: Protein+++, RBCs 1-2 per high power field (HPF), casts 4-5 per high power field,

Liver function tests: Normal.

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