Clinical presentation

A 64-year-old gentleman presented to the emergency department with an episode of angioneurotic oedema ascribed to Valsartan and was noted to have iron deficiency anaemia. He had undergone cardiac transplantation in 1999 and subsequently developed several skin cancers (squamous cell carcinomas and a melanoma removed by the plastic surgeons). Two years prior to this presentation he had been diagnosed with a T3N2 M0 non-small cell lung cancer treated with radiotherapy. The patient was discharged with a plan for outpatient CT study, gastroscopy and colonoscopy but before …