ACE and Q fever: Blood tests were normal, including rheumatologic immune-serologic tests, Vitamin B12 level, creatine phosphokinase (CPK), angiotensin converting enzyme (ACE) level (<12), as well as infectious disease workup, including HIV, hepatitis B virus, hepatitis C virus, syphilis, brucella, bartonella henselae, Q-fever, toxoplasma, and toxocara.