35 year female born in a lower socio economic class lost her father at childhood. She started going to work since very young age. She is younger child to her parents who had two sons before her. Her younger brother suffered from CVA at young age. She loved a guy in her neighbourhood and got married to him. Her marriage life is pleasantful and had no problems. 7 years ago patient had right toe pain and took medications (unknown). Twenty days later she had CVA Rt hemiparesis . Rt upper limb recovered in three days. Lower limb recovered after three months. Later patient had complains of multiple joint pains, occasionally she took pain killers and other medications advised by RMP for her pain. 5 years later patient had complains of cough, cold and sob after getting wet in rain. She was admitted in hospital for one week for pleural effusion. for 2 years she was free from suffering and lead a normal healthy life. In 2024 may patient had facial puffiness went to rmp and was diagnosed with