The 44-Year-old it’s been a while, well, as he is taken to Massachusetts General Hospital in Boston. Ten months ago his shoulder began to pain joints. A rheumatologist examined him and syringe him an anti-inflammatory agent in the shoulders.
In the following months, the fingers and knee joints of the patients began to hurt. The rheumatologist diagnosed fibromyalgia, prescribed inject him with a painkiller and administered it again in the shoulders.
But the man is always sicker. He likes to eat, his stomach hurts. In addition, a stabbing pain in the chest, the increasing plagues him when he is on the back. He sleeps poorly, he coughs. Sometimes he is too exhausted to leave his bed. Overall, he takes off in the ten months to around 18 kilograms, to want to be without it.
Because she cares for him, brings his sister, the man in the emergency room. A blood test revealed that the number of white blood cells is too low.
Fluid in the lungs and in the pericardium
An x-Ray of his chest shows a slight pulmonary edema, a fluid accumulation in the body. Also, between the lungs and the Ribs the Doctors views more fluid than there should be – doctors call this pleural effusion.
The Patient is being transferred to Massachusetts General Hospital. There, the Doctors on the medical history of exactly how, the Team of Sheila Arvikar recorded in a case report in the journal “NEJM”.
The man suffers from Depression, against which he takes a drug. He comes from an African country South of the Sahara, and migrated before the age of 18 years in the USA. For the past 15 years, he has not left the country. According to his own testimony, he drank for a few years, quite a lot of beer, but about 20 years ago, stopped. For 15 years, he also smokes. In his family there are no cases of heart disease, tuberculosis, HIV, auto-immune diseases or cancer.
Tests on influenza viruses, HIV, and Borrelia
The man’s heart beats too fast. His knees and shoulders are warm and pain when they are rotated. Its temperature is slightly increased to 37.7 degrees Celsius.
An infection is causing the discomfort? Tests on influenza viruses, HIV, and Borrelia are negative. However, a Test on cytomegalo virus strikes – this, in particular, can trigger in people with a weakened immune system serious diseases.
Further studies of the heart show that also in the pericardium, which surrounds the body, excessive fluid has accumulated. Such a pericardial effusion can be life-threatening. A certain amount of the liquid ensures that no more can fill the heart properly with blood. Accordingly, it can no longer supply the body with sufficient quantities of the necessary oxygen.
The Doctors move the patients in the cardiology. On the following day his temperature rises to 39.1 degrees Celsius. His heart is racing still.
Tuberculosis, Cancer, Auto-Immune Disease?
The Doctors suck out of the pericardium, which is a good half a Liter of bloody fluid, so that the Organ can work properly again. Then examine the fluid to find out what has caused the pericardial effusion. Possible causes include tuberculosis, cancer, and autoimmune diseases.
A Test on cancer cells is negative, the previous image supplied procedures give no indication of a Tumor. Therefore, the Doctors consider a cancer to be unlikely.
The fever and unintentional weight loss might be suggestive of tuberculosis. However, the test results do not speak against it, also the course of the disease fits.
The doctors go through various rheumatic diseases. Finally, the man suffers from in addition to the heart problem pain in shoulder and knee joints, for example, what’s typical for a rheumatoid Arthritis. However, these possible diagnoses seem unlikely: The values of their white blood cells do not fit into the picture.
A disease, especially women
So the Doctors finally get to another suspicion: Is ill the man is a so-called Lupus erythematosus? This car disease in which the body’s immune system attacks its own tissue, hits immune to 90 percent of women and is therefore not necessarily the first suspect in the case of a male patient.
However, the Lupus could explain all the symptoms: joint pain, the fever, the reduction in the number of white blood cells and the pericardial effusion. As a result of Lupus can inflame the pericardium, which in turn leads to the dangerous effusion. Further Tests to confirm the diagnosis.
The Patient receives two drugs that of the car to counteract immune disease. Already a day later, he’s visibly better. After his release from the hospital, he is cared for in the rheumatology clinic. In the coming one and a half years, he is one of the medications without medical advice and reduces the dose of the other. For some years he lived well until he in pain again severe chest pain, and joint in the emergency room seeking help.