Help Needed
Gary Yin
A good friend of mine's daughter suffers unknown illness and was NOT able
to correctly diagnosed nor treated in China. They are very desperately
seeking advice through the net. Please respond directly to
w...@server1.iapcm.ac.cn or gy...@ucsd.edu. Thank you in advance.
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Summary of Medical Records
Ying Cheng, female, 24, single
Chief complaints: The patient has had pyrexia four times for nine years
with enlargement and pain of nodi lymphatic cervicales and was admitted to
hospital in April 5,1996. In the autumn of 1987, she got a fever without
any discernible cause. Attended by headache and malaise, the temperature
fluctuated from 38C to 40.5C, which was pronounced at night, without
shaking chills, pronounced pains in muscle or joints, nausea, vomiting,
running of nose, sore throat, coughing or phlegm, abdominal pain or loose
bowel movements, frequency, urgency or pains of urination. Four days
latter, She presented with enlargement and pain of nodi lymphatici in the
right side of the neck and had been given "ampiciuin" 6.0/day in drip for
one week and had no response. Then she had also been given "anti-TB"
treatment for one week. Then the temperature fell to normal gradually and
the enlargement in the right side of the neck disappeared. She did not
continue taking medicine after leaving hospital and did not run a fever. In
the spring of 1990, she presented with similar symptoms and had been
running a fever for 4 weeks. On examination, wbc 3400/mm, Hb 9.1g/dl, Rbc
2913/ mm, plt 7.7*104/ mm. Bone narrow puncture: "the proliferation of
erythopoiesis reduces; myelopoiesis has slight toxicity changes". ERS
55mm/hr. Chest X-ray films: "splinter dense shadows of the right lower
hilum laterales; mediastinum nodi lymphatici is not swollen". B-us: "nodi
lymphatici caput pancreatis is swollen". She had been given "piperacillin",
"amikacin" and "erycin" iv drip for 2 weeks and had no response. One week
after the medicine having been stopped, the fever was down. Biopsy of nod
lymphatic: "necrotic lymphadentics". On re-examination, blood picture was
normal. In the autumn of 1993, she presented with enlargement and pain of
nodi lymphatici in another side of the neck. She went to Sino-Japan
Friendship Hospital and was given "glucocorticoids". Three days later, the
fever was down and the swelling disappeared. Twenty-five days ago, she had
similar pyrexia as she caught cold. Ten-odd days later, a nodi lymphatici
in the left side of the neck was swelling and paining. On examination, wbc
5300/mm, chest x-ray films were normal. She had been given "bi-rhizoma
coptidis PO" for one week and "cephalexin ceporex, keflex" for 25 days and
had no response. Two weeks ago, she took "glucocorticoids" by herself and
the temperature had kept normal for one week. However, a week ago, the
temperature risen again after she had stopped taking the medicine. Four
days ago, she caught cold and coughed disconnectedly with scanty amount of
white, viscid sputum without offensive odour or blood. She was admitted to
hospital. Ever since the disease came on, the patient had no hectic fever
in the after noon or night sweat. Without dry in mouth or eyes, enlargement
nose-blood or gum-blood. The skin was free from nodule, erythema and itch.
Urine and stool were as usual. She lost 4 kilograms in one month.
Physical examination: T37.8C, P100/minute, R 20/minute, BP 110/70mm Hg. A
shelled-peanut-sire nodi lymphatici sternocleido mastoid muscle interna may
be palpable in the middle of the left side of the neck. It was tenacious
and somewhat loose. Tenderness was evident. Epidermis was absent from red,
swelling and ulceration. The other nodi lymphaticis superficials inferiors
were untouched. Throat was a little congested. Both tonsils were
swollen(I). Neck had no resistance. Heart, lungs and abdomen were normal.
Spine, arms, legs and joints were normal. Edema was absent from legs.
Babinoski's sign(-), kernig's sign (-).
Initial Diagnosis: Virus Lymphadenitis
Lab Examination: wbc 3.7~4.4*10/L, Rbc 3.52~4.34*10/L,Hb 10.0~14.3g/dl, plt
8.3~10.8*10/L, ESR 32~51mm/br, band cell 0~6%, lobocyte 46~70%, lymphocyte
22~52%, monocyte 2~4%, no abnormal lymphocyte. Routine urine and stool are
both normal. HBSAG(-), 2 PP.D test (-), cuti-TB-AB(-), ENA spectrum:
anti-SSB(+), the others(-), ANA(-), DNA (-), C3 1.08mg/ml (normal 0.7~1.0),
C4 1.73mg/ml (normal 0.2~0.4), Ig: Igm 2.21g/l (a little higher), the
others are normal. ASO 1:800, RF(+), CRP(+), chest x-ray films are normal.
B-us: "spleen is a little bigger". No enlarged nodi lymphaticiscun be seen
in the abdomen. Eca is normal. EB PCR(-).
Anyone can help please send e-mail to E-mail: w...@server1.iapcm.ac.cn
or gy...@ucsd.edu. Thank you in advance.