Urgent!!! Need diagnostic advice for sick friend
Cai Quanqing
Hi,
I hope everyone who can help us will sendmail to us
This is Peking University in China, a place those dreams of
freedom and democracy. However, a young, 21-year old student
has become very sick and is dying. The illness is very rare. Though
they have tried, doctors at the best hospitals in Beijing cannot cure
her; may do not even know what illness it is. So now we are asking
the world -- can somebody help us?
Here is a description of the illness:
The young woman -- her name is Zhu Ling -- is a student in
the chemistry department. On DEC. 5, 1994, Zhu Ling felt sick to
her stomach. Three days later, her hair began to fall out and within
two days she was completely bald. She entered the hospital, but
doctors could not discover the season for her illness. However,
after she was in the hospital for a month, she began to fell better
and her hair grew back. Zhu Ling went back to school in February,
but in March her legs began to ache severely, and she felt dizzy.
She entered XieHe Hospital - Chinese most famous hospital. In
early March and on March 15, her symptoms worsened. She Began
to facial paralysis, central muscle of eye's paralysis, self-controlled
respiration disappeared. So she was put on a respirator.
The doctors did many tests for many diseases(include anti-
H2V, spinal cord puncture, NMR, immune system, chemical drug
intoxication ANA,ENA,DSONA,ZG and Lyme), but all were
negative, except for Lyme disease(ZGM(+)).
The doctors now think that it might be acute disseminated
encephalomyelitis(ADEM) or lupus erythematosus(LE), but the
data from the tests do not support this conclusion.
The doctors are now treating Zhu Ling with broad-spectrum
antibiotic of cephalosporin, anti-virus drug, hormone, immun-
oadjuvent, gamma globulin intravenous injection and have given
her plasma exchange(PE) of 10,000 CCs. But Zhu Ling has not
responded -- she reamers in a vegetative state, sustained by life
support.
If anyone has heard of patients with similar symptoms -- or
have any ideas as to what this illness could be, please contact us.
We are Zhu Ling's friends and we are disparate to help her.
This is the first time that Chinese try to find help from
Internet, please send back E-mail to us. We will send more crystal
description of her illness to you.
Thank you very much
Peking University
April 10th, 1995
==========================================================================
Please foreword this message to your freinds if you think they can help
us ,Thanks advanced!
Abstract of Case History(Medical Record)
Patient Zhu Ling is female, 21 years old. She was born in Beijing.
In March 15th 1995, she hospitalized as she had trichomadesis, and
felt abdominal pain, joints and muscles aching pain for more than
three months; pain in digital portion of both lower limbs for seven
days and dizzy for three days. Since Dec. 8th. 1994(more than 3
months before this hospitalization)she felt abdominal pain that was
sustained and light with episodic griping pain and without any
inducing cause. In Dec. 23rd 1994 she hospitalized another hospital
to be accepted series of examinations and treatments. All results of
ANA, ENA, dsDNA, Ig, protein electrophoresis, T3, T4, TSH were
normal. The radiogram of spenoid saddle, CT of adrenal glands, B-
Ultrasonic examination of abdomen and pelvix, and radiogram of
bone marrow were normal. There was no abnormal result in routine
chemical tests. There were severe abnormal signs in microcirculation
of nail folds. About one month later, trichomadesis was appeared to
the highest degree most obviously. She had been accepted nourished
and Chinese traditional treatments to make her symptoms, mentioned
above, were gradually alleviated. She was discharged from that
hospital without any determined diagnosis.
In Mar. 7th she went to a doctor in our hospital, as she had felt
pain in digital portion of both limbs. It was showed that she had a
“peripheral nerve pain” by the physical examination. Three days later
she felt dizzy, objects rotation oculrogyric crisis, fidgety and
consciousness indistincted. Then she hospitalized our hospital in
Mar. 15th. 1995. Her blood pressure was 140/110 mm Hg. Both eyes
showed episodic turning upward, horizontal and vertical nystagmus
and abduction incompleted. Bilateral facial paralysis, hypersensitive
pain in digital portions of four limbs, hypo tendon reflexes of both
lower limbs were found. Muscular force was IV degree. Hyper
sensitive skin trace response was showed. After hospitalization CFS
showed normal in Mar. 15th. 1995, by lumbar puncture examination
Routine biochemical tests were normal. Any abnormal phenomenon
was not found with MRI of skull in Mar. 16th. EEG showed light
abnormal. Any obvious abnormal result was not found in EMG. The
disease progressed very rapidly. Spasms colonicus of both upper
limbs, consciousness transferred from fidgety to drowsy, tonic
episodes of both upper limbs and oculogyric crisis were appeared.
Since 5 days after hospitalization she has been in coma with bulbar
paralysis and central respiratory failure. Tracheolaryngotomy was
operated to help her respiratory action by respirator. Blood
examination showed anti-HIV(-), Lyme antibody IgG(-),IgM(+).
Urine as was normal by quantitative analysis. CFS pressure was
normal in Mar. 22, 1995. EEG was severe abnormal. ANA, ENA,
dsDNA, urine hepato-bilinogen(-). Since hospitalization
treatments(hydrocortisone IV, plasma replacement, anti infectious
and anti viral treatments)were given. Now, she is still in come with
both eyes floating. and hypo tendon reflex as of four limbs. No
pathological sign was induced
Thanks for all yours help!
=================================================================
email: ca...@mccux0.mech.pku.edu.cn
Address: 32# Room 134 Perking University,BeiJing, China
Postcode:100871
D.W.W. Bullimore
>From: eye...@mindlink.bc.ca (David Nelson)
>Subject: Re: Urgent!!! Need diagnostic advice for sick friend
>Date: Thu, 13 Apr 1995 21:27:10
>In article <3memfb$8...@linuxguy.pku.edu.cn> ca...@mccux0.mech.pku.edu.cn (Cai Quanqing) writes:
>>Path: news.mindlink.net!agate!hpg30a.csc.cuhk.hk!linuxguy.pku.edu.cn!mccux0!caiqq
>>From: ca...@mccux0.mech.pku.edu.cn (Cai Quanqing)
>>Newsgroups: sci.med,sci.med.diseases.cancer,sci.med.immunology,sci.med.informatics,sci.med.nursing,sci.med.nutrition,sci.med.occupational,sci.med.pharmacy,sci.med.physics,sci.med.psychobiology,sci.med.radiology,sci.med.telemedicine,sci.med.transcription
>>ci.med.vision
>>Subject: Urgent!!! Need diagnostic advice for sick friend
>>Date: 11 Apr 1995 19:48:59 GMT
>>Organization: Peking Universary,China
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>>Message-ID: <3memfb$8...@linuxguy.pku.edu.cn>
>>NNTP-Posting-Host: 162.105.195.2
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>>35 sci.med.radiology:1875 sci.med.telemedicine:4993 sci.med.transcription:1255 sci.med.vision:3680
ZHU LINGS PROBLEMS SOUND LIKE THALLIUM POISONING THE COMBINATION OF ACUTE HAIR
LOSS, GASTROINTESTINAL AND NEUROLOGICAL PROBLEMS IS ALMOST PATHOGNOMONIC.
UNLESS SHE WORKSWITH THALLIUM (AS IN PRODUCING OPTICAL LENSES) THEN IT IS
LIKELY THAT SHE ISBEING POISONED DELIBERATELY. PLEASE PROVIDE ME WITH FOLLOWUP.
YOU MAY BE INTERESTED IN REFERENCE: FELDMAN D, LEVISOHN DR "ACUTE ALOPECIA:
CLUE TO THALLIUM TOXICITY" PEDIATRIC DERMATOLOGY 10910;29-31 1993 MARCH.
ABSTRACT: COMBINATION OF RAPID DIFFUSE ALOPECIA, NEUROLOGICAL AND
GASTROINTESTINAL DISTURBANCE IS PATHOGNOMONIC FOR THALLIUM POISONING. THE HAIR
MOUNT SHOWED A TAPERED OR BAYONET ANAGEN HAIR WITH BLACK PIGMENTATION AT THE
BASE MAY BE HIGHLY DIAGNOSTIC BEFORE THE ONSET OF ALOPECIA. WE SAW A 10 YEAR
OLD BOY WHO SUFFERED FROM THALLIUM POISONING (END ABSTRAST)
YOU SHOULD BE ABLE TO DETECT THALLIUM IN THE HAIR WITH A MASS SPECTROMETER I
WOULD HAVE THOUGHT.
HOPE THIS IS OF HELP
>I will attempt to forward your message to the eye specialists and
>neuro-ophthalmologists of north america to see if anyone can be of
>assistance.
>Best Wishes,
>David Nelson, M.D.
William Palmer
absorbtion spectrometer is the tool to use to discover this. These are
found in university chemistry departments, big hospital labs, public
health labs, industrial labs. I can send you normals. It can be done on
serum or urine or hair. They can assay many other heavy metals also.
A good screen for many heavy metals is a test for delta aminolevulinic
acid, which most hospitals do to diagnose acute intermittent porphyria.
This is because heavy metals--and I believe thallium--interfere with the
conversion of ALA into a heme precursor and ALA "piles" up in the serum
and urine. It should be less than 7.5mg/24 hr urine.
Sneak some specimens out of the hospital!
Best to you, William Palmer, MD
--
William Palmer
Anatomic Pathology Institute
Oakland, CA 94618
dn...@dnai.com
Dr. Stephen Dubin
there is a benchtop chemical test for thallium which isdescribed in
Fiegel's Spot Tests (Vol 1 - inorganic) and which was adapted for dog
urine in: Gabriel K, Dubin S: A method for detection of thallium in
canine urine. Journal of the American Veterinary Medical Association
143: 722 - 724 (1963).
Other non-instrumental tests are described in a book called "Thallium
Poisoning" by Jonothan Prick.
--
| Stephen Dubin VMD, PhD | |
| Biomedical Engineering & Science Institute | Phone: 215-895-2219 |
| Drexel University, Philadelphia PA 19104 | Fax: 215-895-4983 |
| email: dub...@duvm.ocs.drexel.edu | |
William Palmer
(Dr. Stephen Dubin) wrote:
> In case instrumental (AI absorbtion, Spectrophotometer etc) is not available,
> there is a benchtop chemical test for thallium which isdescribed in
> Fiegel's Spot Tests (Vol 1 - inorganic) and which was adapted for dog
> urine in: Gabriel K, Dubin S: A method for detection of thallium in
> canine urine. Journal of the American Veterinary Medical Association
> 143: 722 - 724 (1963).
> Other non-instrumental tests are described in a book called "Thallium
> Poisoning" by Jonothan Prick.
I actually called China today! She is still in coma. I called a local
Poison Center and UCSF's Drug Info Center! Probably the best chelator is
DMSA, dimethyl succinic acid, which is taken 10mg/kg, tid for 5 days, then
bid for 14 days. This is still not the best treatment, which people feel
is hemodialysis.
Another possibility for treatment, according to mouse experiments, is
Penicillamine together with Prussian blue(ferric thiocyanate). See
Toxicology, 1992, Aug. Vol 74 page 69-76, an article by Rios. Another
article is Toxicology 1994, March 25, Vol 89, part 1, p 15-24 by
Barrose-Moguel.(sp?). Dithiocarbamate is a standard Tx. but folks are
afraid that its thallium-carbamate complex has a high partition
coefficient in the brain and that the brain actually becomes a sink for
thallium. The person I talked to in Peking thought they might be able to
secure the DMSA someplace. I do not want to blab details here. Hard to
talk with him. I have a Chinese employee who did some of the talking. I am
convinced this is a bone-fide genuine problem, and not some weird Net
ploy.
I am not sure if you folks have the thallium levels actually done on her.
They were very high!...in serum, urine, hair, nails! Bill Palmer
Mark Rendulic
I was going through some old mail here and noticed the messages
concerning this sick girl. I was wondering how she is doing now and what
steps are being taken to ensure her recover.
Thanks
Mark