Chapter 765: The truth of the case is revealed
"No way..." Doctor Gu pressed his temple.
Just hearing it is enough to give me a headache...Does Doctor Xu face these complicated situations every day?
Shi Lian also rubbed her head: "My head hurts. But this is the only way to make progress."
She looked at it carefully again and was suddenly stunned.
The main clinical manifestation of herpetic dermatitis is multiple symmetrical blister rashes on the body, and only a small number of people have gastrointestinal manifestations.
In other words, even if it is confirmed, it should be enough to do a skin biopsy. What's the point of adding a small intestinal biopsy?
Most herpetic dermatitis is not accompanied by gastrointestinal damage.
Even if Jiang Qiang has symptoms of diarrhea, it does not mean that intestinal biopsy can find damage.
Unless... intestinal biopsy is not for diagnosing herpetic dermatitis at all!
"Yes, that should be the case!"
Shi Lian couldn't think of what the disease was for a while, but she could see that her teacher was definitely not rushing to herpetic dermatitis.
She quickened her pace and quickly handed the report to Xu Qiu.
At the same time, she also explained her guess.
Xu Qiu looked up at Shi Lian and nodded, "You guessed right, dermatitis herpetiformis is not the point."
"So teacher, do you think the patient does not have dermatitis herpetiformis?"
"No, this is dermatitis herpetiformis."
Shi Lian was a little confused when he heard this.
Xu Qiu put out the intestinal biopsy report and said, "One of the difficulties in diagnosing dermatitis herpetiformis is that the cause is unknown. But the pathogenic mechanism of this patient is clear."
This sentence completely awakened Shi Lian. She immediately ruled out diseases that could induce dermatitis herpetiformis, and then thought of the patient's methemoglobinemia...
After a moment, her eyes flashed with an indescribable brilliance, and she said in surprise, "Is it celiac disease?"
Xu Qiu nodded slowly.
The rash is not the point, diarrhea is.
Dermatitis herpetiformis is not the main symptom, and diarrhea is not caused by dermatitis herpetiformis. On the contrary, celiac disease causes diarrhea and triggers dermatitis herpetiformis. This is the true pathogenesis of the disease!
Shi Lian had a sudden realization: "It's just dermatitis herpetiformis, and it's impossible for abnormal intestinal biopsy to appear in the short term. But if it's celiac disease, everything can be explained!"
The direct manifestation of celiac disease is diarrhea, chylous diarrhea.
"No, if it's celiac disease, the patient has to accept a gluten-free diet for life, how can..."
As he spoke, Shi Lian was suddenly stunned, and his expression became extremely shocked.
A gluten-free diet means food that does not contain gluten, such as common wheat, rye, barley and other products.
Celiac disease has another nickname, gluten enteropathy, and its onset is closely related to eating wheat flour. Patients are extremely sensitive to gluten, wheat flour, etc. Any food that can be broken down into gluten protein by ethanol is a pathogenic factor of the disease...
Therefore, patients with celiac disease must maintain a gluten-free diet for life.
Shi Lian didn't notice this at first, but after Xu Qiu reminded her, she remembered that Jiang Qiang's meals were not ordered from the hospital, but brought from home by her husband...
They naturally thought that this was a sign of the couple's love, but they didn't expect that asking one more question would lead to clues!
"Wait... Teacher, even if it's celiac disease, it doesn't seem to be associated with methemoglobinemia." Shi Lian thought carefully and realized that something was wrong.
From celiac disease to methemoglobinemia, it spans several systems.
The various drugs that Xu Qiu suspected before, such as dapsone, were all used in other departments, and they didn't seem to be related to celiac disease.
Xu Qiu said lightly: "Think about the indications of dapsone again."
Shi Lian thought about it and said: "Various types of leprosy, combined with trimethoprim to treat Pneumocystis carinii, combined with pyrimethamine to prevent chloroquine-resistant malaria, and more..."
She carefully recalled the knowledge she had memorized in the pharmacology class.
Suddenly, Shi Lian was stunned and said with her mouth open: "There is also... dermatitis herpetiformis!"
At this moment, the boring text about dapsone in the textbook became a living medical record, and the relationship between dapsone-dermatitis herpetiformis and medication was deeply engraved in Shi Lian's mind.
...
After Xu Qiu confirmed the symptoms, Wang Fan and others immediately resumed the ward rounds.
The truth of this case was finally revealed.
Jiang Qiang had diarrhea before, and she also asked the doctor in the clinic to prescribe oxytetracycline.
It worked at first, but then the effect decreased, so Jiang Qiang secretly increased the dosage.
In the end, the diarrhea still couldn't be cured, so she went to the clinic again.
This time the doctor prescribed dapsone.
Because the clinic's drugs were packaged in paper boxes, Jiang Qiang and her husband didn't know that the drugs had been changed this time. After taking them back, they put them back in the previous oxytetracycline bottle as usual.
Because she was worried that it wouldn't work, Jiang Qiang took the dosage of the medicine according to the amount that was superimposed before.
There was no problem in the first few days, until this time, when she took an overdose of dapsone again, methemoglobinemia finally broke out, and her blood oxygen level dropped to 39 right away, and she almost died on the way...
Dapsone.
This is an infectious drug familiar to all clinicians, and it is also the main drug against leprosy.
But few people know that it can also be used for herpetic dermatitis!
...
A few days later, Jiang Qiang was discharged from the hospital.
Her medical records have also become teaching demonstrations in the hospital, and are one of the classic cases for interns entering the medical field.
The rare indications of commonly used drugs were overlooked by even Wang Fan and other experienced clinicians. If Xu Qiu had not insisted on finding out the inducing factors after diagnosing methemoglobinemia, no one would have thought of this.
Jiang Qiang is also very likely to take dapsone as oxytetracycline again.
However, the next time methemoglobinemia is induced, the situation may be more serious, and it may not be saved.
…
After sending Jiang Qiang away, Xu Qiu had no time to relax his mind, and the emergency room called again.
Under normal circumstances, Yunmei, Yang Yuen and others can handle it well. Those who can call Xu Qiu's office are basically urgent and severe cases that Wang Ping and other directors are not safe.
"What's the situation?" Xu Qiu bumped into Shi Lian who was rushing in from the emergency hall.
Shi Lian's face turned pale with fear, and she said, "Teacher, this is a patient with acidosis. Director Wang Ping took a look and asked you to come!"
Xu Qiu was shocked.
Wang Ping is an expert in the field of emergency respiratory medicine, and his level is ranked among the best in the province. He doesn't say whether he can save most patients, but he will never ask Xu Qiu to come after just one look...
"How is the situation?" Xu Qiu asked quickly.
Shi Lian said easily, "The condition has stabilized for the time being. Director Wang Ping is in charge of the emergency room and is waiting for you to come."
Xu Qiu was slightly relieved.
