Make a diagnosis ... real problem

[dara678]

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So this guy who developed some linux thing has a variety of symptoms consistent with some kind of infection, but none of his docs can figure out what it is ... since I'm taking my microbio+immuno test tomorrow, i thought this was interesting ... waht do you guys think?

the doctors I've seen have been
unable to find signs of infection, and my blood ESR is normal.
Nevertheless, the signs of complications from an infection are quite
clear. I've had a number of pulmonary "pops" that are either burst
lung abscesses or blebs, and things have spread in a bad way. A
thickening of my pleura has been noted, as well as pericarditis.
Most disturbing of all, I have developed mitral valve prolapse and
regurgitation. I've had a fever and soaking night sweats. I can't
stand for too long without getting faint. Lately I've been spending
a lot of my time on the floor. I have no history of heart problems
and when I got the first chest pains (crushing ones) I went to the
ER immediately. This was on 11/10. They found nothing wrong and
sent me away. The next day I saw an internal medicine MD who gave me
a complete exam including carefully listening for heart problems, and
found nothing wrong. The pain continued, and by the time I got to
the Mayo I had heart trouble so obvious that nobody has failed to
recognize it since. However, it's been a problem getting anyone to
consider that this is a new problem. Most of the people I've seen
think that they are the first to notice it and that everyone before
them must have missed it, and that I've certainly had it my whole life.
But having recently had a major infection and fever and developing a
new murmur and chest pains I'd think it would be only prudent to
treat this as complicated infective endocarditis. I've been to
another different ER with more crushing chest pains since then and
have begged for a needle biopsy to check the plural fluid for empyema,
but nobody will do this diagnostic either.

For the full read, go here: ftp://ftp.slackware.com/pub/slackware/slackware-current/PAT-NEEDS-YOUR-HELP.txt

 

[dave262]

The funny thing about Occam's razor is that William of Occam died of multiple causes.

hope that helps.

 

[Rendar5]

That just screams out autoimmune disease. Don't ask me which one, but it's obviously following a long-term infection and involves various inflammations and attacks on tissues (mitral valve).

Of course, I'm a lowly MS1 and barely know 1 disease from another. So i could be totally botching this. How do we contact this guy?

 

[phoenixsupra]

The funny thing about Occam's razor is that William of Occam died of multiple causes.

hope that helps.

Yes, that's slightly funny.

 

[aphistis]

The funny thing about Occam's razor is that William of Occam died of multiple causes.

hope that helps.

Priceless. You're getting a quote in my signature for that one.

Oh, and Rendar5 - Giving out diagnoses online based on an anonymous, incomplete history over the internet is a good way to get yourself in trouble. 😉

 

[Rendar5]

Priceless. You're getting a quote in my signature for that one.

Oh, and Rendar5 - Giving out diagnoses online based on an anonymous, incomplete history over the internet is a good way to get yourself in trouble. 😉

haha, totally. that's why I told him what he had through an anonymous e-mail so I couldn't get in trouble when I give him a misdiagnosis 🙂 no, just joking. I e-mailed him, and just let him know that he might want to speak to his doctor about the possibility that some symptoms are related to autoimmunity problems and not infectious or congenital problems. I wasn't even going to risk giving him any disease names. just suggested a broad area to check out with some qualified doctor who could actually see him in person.

 

[dara678]

Oh, and Rendar5 - Giving out diagnoses online based on an anonymous, incomplete history over the internet is a good way to get yourself in trouble. 😉

just curious ... what can happen??

i just posted this online cuz this guy's story is pretty tragic 🙁 seems like he has nowhere to go and seems like its a mystery no one person can solve ...

 

[kinetic]

I think it's a guy who spends too much time watching "ER" and reading stuff on the Internet. (Yes, yes, I can hear the gasps of horror already and the cries of how little compassion I have. It's all very nice.) I'm going to sleep right now, but I'll be happy to tell you why I call B.S. on him tomorrow if you want.

 

[DadofDr2B]

So this guy who developed some linux thing has a variety of symptoms consistent with some kind of infection, but none of his docs can figure out what it is ... since I'm taking my microbio+immuno test tomorrow, i thought this was interesting ... waht do you guys think?

the doctors I've seen have been
unable to find signs of infection, and my blood ESR is normal.
Nevertheless, the signs of complications from an infection are quite
clear. I've had a number of pulmonary "pops" that are either burst
lung abscesses or blebs, and things have spread in a bad way. A
thickening of my pleura has been noted, as well as pericarditis.
Most disturbing of all, I have developed mitral valve prolapse and
regurgitation. I've had a fever and soaking night sweats. I can't
stand for too long without getting faint. Lately I've been spending
a lot of my time on the floor. I have no history of heart problems
and when I got the first chest pains (crushing ones) I went to the
ER immediately. This was on 11/10. They found nothing wrong and
sent me away. The next day I saw an internal medicine MD who gave me
a complete exam including carefully listening for heart problems, and
found nothing wrong. The pain continued, and by the time I got to
the Mayo I had heart trouble so obvious that nobody has failed to
recognize it since. However, it's been a problem getting anyone to
consider that this is a new problem. Most of the people I've seen
think that they are the first to notice it and that everyone before
them must have missed it, and that I've certainly had it my whole life.
But having recently had a major infection and fever and developing a
new murmur and chest pains I'd think it would be only prudent to
treat this as complicated infective endocarditis. I've been to
another different ER with more crushing chest pains since then and
have begged for a needle biopsy to check the plural fluid for empyema,
but nobody will do this diagnostic either.

For the full read, go here: ftp://ftp.slackware.com/pub/slackware/slackware-current/PAT-NEEDS-YOUR-HELP.txt

Please note I am not a doctor or medical student but a patient who has chronic kidney disease as a result of autoimmune disease. This appears to be an extensive case of the autoimmune system attacking organs. My existing treatment includes prednisone for anti inflammation, Chemo of Cytonax, to stop the immune system from further progression, and Davion(?) for hypertension. My daughter has type 1 diabetes which is an autoimmune disease that attacks the insulin producing part of the pancreas. In 20% of Type 1 diabetics the autoimmune system attacks the thyroid and requires replacement hormones. The immune system seems to be attacking the organs.

 

[13538]

FWIW, endocarditis should be in the DDx. ESR means nothing on its own...
A new murmur + fever = endocarditis until proven otherwise. He needs a careful Hx taken (ie- recent dental, URT, GU, GI procedures etc). He should have had 3x blood cultures on 3 consecutive days from different sites. Urinalysis for haematuria, casts etc. Bloods for WCC, ESR, CRP, U+E etc. Serology. CXR. ECG. Echocardiography (trans-oesophageal). If it is endocarditis, he needs a bucket of ABx IV for at least 4-6 weeks, depending on the bacteria isolated and the sensitivities. Mortality is high enough.

To be honest, I don't believe a word he's saying - he's been watching too much ER. Any doctor worth his/her salt would have worked this up....they'd be negligent otherwise. There's something he's not telling us...typical patient!!!!

 

[Rendar5]

what he's not saying is that these symptoms pretty much appeared after he had been sick with some rare infection for a year and had then been cured. of course, his two posts on that site are like only 8 days apart, not quite enough time to see all those doctors, I would think. which is a problem (I now agree, probable BS)

FWIW, endocarditis should be in the DDx. ESR means nothing on its own...
A new murmur + fever = endocarditis until proven otherwise. He needs a careful Hx taken (ie- recent dental, URT, GU, GI procedures etc). He should have had 3x blood cultures on 3 consecutive days from different sites. Urinalysis for haematuria, casts etc. Bloods for WCC, ESR, CRP, U+E etc. Serology. CXR. ECG. Echocardiography (trans-oesophageal). If it is endocarditis, he needs a bucket of ABx IV for at least 4-6 weeks, depending on the bacteria isolated and the sensitivities. Mortality is high enough.

To be honest, I don't believe a word he's saying - he's been watching too much ER. Any doctor worth his/her salt would have worked this up....they'd be negligent otherwise. There's something he's not telling us...typical patient!!!!

 

[dara678]

To be honest, I don't believe a word he's saying - he's been watching too much ER. Any doctor worth his/her salt would have worked this up....they'd be negligent otherwise. There's something he's not telling us...typical patient!!!!

I guess so ... I can see what you're saying. I'm just an MSI, so I guess I tend to take everything a patient says seriously. 🙁 Haven't learned to distinguish it yet ....

 

[vigils]

I have developed mitral valve prolapse and
regurgitation. I've had a fever and soaking night sweats. I can't
stand for too long without getting faint ...

But having recently had a major infection and fever and developing a
new murmur and chest pains I'd think it would be only prudent to
treat this as complicated infective endocarditis.

crushing chest pains since then and have begged for a needle biopsy to check the plural fluid for empyema, but nobody will do this diagnostic either. [/url]

I read this a couple days ago but didn't reply becuase I thought it was a joke! I still think it might be. Seriouly, this guys screwed up, mitral valve prolapse is not normal. But to request a needle biopsy! thats crazy. If you're not even admitted to the ER at the hospital, you don't need to check for empyema! Pus in the pleural space for all you wondering (don't hate me!). It is not normal for even pneumonia becuase the infections are generally well treated, stay in the lung, and don't eat all the way into the pleural space! His complaint of syncope given his information (becuase its truely not a history) would indicate his syncope is related to his heart condition (or meds don't forget), anxiety, he's going crazy insane in sharp contrast to the fact that ED after ED tell him he's fine. This is striking becuase ED's generally error on the side of caution, admitting and doing every test when possible.

So my diagnosis would have to include one any combination of these things:

1. CHF
2. Anxiety
3. Factitious disorder (oh yeah, I know you guys will love that one, don't forget the love for the psych disorders!)

 

[mpp]

This is not B.S. Although, you'll likely have a difficult time diagnosing this guy over the internet. I saw this patient when he was at the Mayo Clinic. A difficult case indeed...I wish him the best.