Chapter 764 Another diagnosis of unknown cause?

"Xu Qiu, you haven't found out the reason yet?" Wang Ping asked.

Xu Qiu shook his head: "I have no clue."

Wang Ping thought: "The most common one is nitrite poisoning. Every year there are a lot of news about accidental ingestion of industrial salt."

"It has nothing to do with salt."

Wang Ping understood the subtext, and it had nothing to do with pickled food.

He thought for a while and then said: "Rotten vegetables may also contain excessive nitrite."

Xu Qiu had already considered these factors. He frowned and said, "It is more likely to be drug factors, such as local anesthetics or dapsone."

Dapsone is a drug that is highlighted in textbooks, but is unfamiliar to clinicians.

The reason is that it is rarely used nowadays, that is, it is seen more often during medical student examinations.

Xu Qiu continued: "Local anesthetics are not considered, and patients have no chance to come into contact with these things."

Controlled drugs are not available to ordinary people.

"Dapsone? I'm familiar with this. When I was rotating in the infectious disease department, I met a leprosy patient who happened to use this drug!" Wang Fan raised his hand with a proud expression.

Xu Qiu was slightly surprised.

Dapsone is indeed a drug used by the infectious disease department, and the main symptomatic disease is leprosy.

However, because leprosy is rare, dapsone is rarely prescribed, and many of the drugs that expire every year are dapsone.

Wang Fan stood up and said, "Brother Xu, leave it to me to ask."

Xu Qiu guessed that the breakthrough point would be the medicine, and it would not be difficult. In addition, he had surgery in the morning, so he agreed.

At noon, Xu Qiu returned to the office after completing the operation.

Not long after, Wang Fan came to report the situation.

"Brother Xu, I asked and the patient has never had leprosy."

"Only asked about leprosy?"

"Of course not. Dapsone is also a drug for the prevention and treatment of Pneumocystis carinii in AIDS patients. Although it is a third-line drug, trimethoprim and sulfamethoxazole are often used clinically. But I still asked about them, but the patient Not consistent either.”

All four preoperative procedures were done, and Jiang Qiang did not have any of these infectious diseases.

Wang Fan spread his hands and said: "However, the patient's medical history is not complete enough. She was in a coma yesterday, so she was not found. But when I woke up this morning, I checked again and found that the patient still has some dermatitis. Brother Xu, do you think you should prescribe some medicine. "

Xu Qiu immediately frowned.

The patient's family members are indeed very careless... He asked again and again yesterday, but except for diarrhea, there were no other questions. This morning's ward round found the omission.

"Let's go take a look in the afternoon." Xu Qiu said.

He is now more concerned about why methemoglobinemia is induced.

According to his guess, the medical history he asked before could basically rule out the cause, except for drug induction.

Other than dapsone, certain drugs used to treat malaria, urethritis, and red and painful urination can also cause it.

But Wang Fan also asked by the way, and got the same negative answer.

Xu Qiu brought up Jiang Qiang's medical record page and slowly scrolled through it.

Suddenly, he looked at Wang Fan.

"You said the patient had dermatitis and diarrhea?" Xu Qiu asked.

Wang Fan was a little confused: "Yes, I also asked, the patient applied erythromycin ointment himself."

"How long?"

"It seems to be about four days."

"Not okay yet?"

"Yes, I guess it's not folliculitis or purulent skin disease, so I asked Brother Xu to have a look and prescribe the right medicine." Wang Fan is just an emergency doctor and doesn't know much about dermatology diseases.

But Xu Qiu was keenly aware that something was wrong.

"What did they eat for lunch?"

Wang Fan was stunned for a moment: "Is this also important?"

Xu Qiu nodded, got up and went to the ward.

It was meal time at this time, and the patients in the same ward had already started eating, but Jiang Qiang was still lying on the bed, and her husband was nowhere to be seen.

"Aren't the family members here?" Xu Qiu glanced at him.

Jiang Qiang thought it was the ugly doctor from the morning again, so she responded listlessly, but after subconsciously glancing at Xu Qiu, she sat upright.

Wang Fan:? ? ?

How about being so realistic?

Xu Qiu put on his gloves and said, "I need to check the individual, please cooperate."

"Okay!" Jiang Qiang said nothing.

"You have a rash?"

"It's found in several places, under the armpits, on the chest, and on the butt..."

"No, there's no need to take off your clothes." Xu Qiu stopped her without changing her expression.

Wang Fan silently pulled Shi Lian over... If there were no medical personnel of the opposite sex present, he was really worried that something would happen to Xu Qiu.

After Shi Lian arrived, she helped Jiang Qiang pull up her clothes.

Xu Qiu took a closer look.

Groups of blisters grew in the patient's armpits, closely arranged, covering the skin like a map, with different shapes and sizes, the largest being about two centimeters.

The blisters are connected into sheets, and the surrounding skin is red and swollen.

At first glance, it looks like dense fish scales, but the patient's fish scales are blisters close together.

Xu Qiu tried to press it.

The texture of the blisters is tight, and judging from the surrounding intact blisters, they are not easy to break, otherwise they would have been eroded in pieces under the wear and tear of the skin.

"Is it itchy?"

"It's itchy! Every time I can't help it, I take a cold shower. If I can't help it anymore, I apply some erythromycin ointment."

"Does it hurt?"

"It hurts sometimes!"

Xu Qiu nodded, he probably knew it well.

Wang Fan said in surprise: "Isn't this an ordinary infection?"

"no."

After Xu Qiu finished speaking, he added: "Do a skin biopsy and small intestinal biopsy."

Wang Fan and Shi Lian were stunned at the same time.

Skin problems, why do we need intestinal examination?

Could it be possible that the patient's diarrhea has another cause?

…

Soon, the patient's examination report came out.

Skin biopsy showed that there were micro-abscesses around the capillaries in the patient's dermis and the top of his head, and there were accumulation of neutrophils and eosinophils. Subepidermal blisters could be seen in the blister group, and there were also eosinophils and neutrophils around the blood vessels in the dermis. Infiltration of granulocytes...

A biopsy of the small intestine also revealed abnormalities.

Jiang Qiang's intestinal epithelial appearance has undergone mild atrophy, and the lymphoid tissue cells and plasma cells in the membrane propria have also been infiltrated!

"Herpetic dermatitis?" In the laboratory department, Dr. Gu sent Xu Qiu's patient over as soon as he saw the results came out.

I met Shi Lian on the way.

Shi Lian also immediately thought of herpetic dermatitis.

This is an immune disease of unknown etiology. It has genetic susceptibility and is very rare clinically. Its main manifestation is a polymorphic rash mainly composed of blisters. The rash is often accompanied by severe itching and occasionally burning and pain. In a few cases, it also occurs at the same time. Accompanied by gastrointestinal symptoms such as diarrhea and bloating.

If you are not an experienced doctor, you may be misdiagnosed as eczema and delay treatment.

Seeing this report, Shi Lian was immediately troubled.

My teacher wanted to find the cause of methemoglobinemia, but after searching, he discovered herpetic dermatitis?

Now not only is the methemoglobinemia unexplained, but also herpetic dermatitis of unknown cause!

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