Medical Mystery: What’s Wrong With Me?

THE PATIENT: Alec, eight years old THE SYMPTOMS: Headache, cough and nausea

THE DOCTOR: Dr Stuart Whitelaw, consultant surgeon, Dumfries and Galloway Royal Infirmary, Scotland

ONE DAY LAST October, Alec came home from school with a headache. The next morning, he woke with a dry cough and scratchy throat. His eyes were red and sensitive to light, and his legs ached. Alec’s parents figured he had the flu and decided to keep him home till he felt better. A week later, his symptoms hadn’t improved. When Alec grew nauseous and began vomiting, the family went to the emergency department of their local hospital.

Doctors there noticed that Alec’s pulse was speedy, around 120 beats per minute, and he had a fever of 38.5°C. When they gently touched his calves, he cried out in pain. Suspecting meningitis, the doctors gave him intravenous fluids and a broad-spectrum antibiotic. Nine days had passed since the onset of his symptoms, and he’d since developed a blotchy rash on his back and abdomen. He also had blood in his urine.

Alec was tested for meningitis, viral hepatitis and typhoid fever, but the results came back negative. Four days after he’d been admitted, he began showing signs of septic shock: his heart rate and temperature were elevated, his blood pressure was low, he had difficulty breathing, and he was producing less urine than he should be. He was put on oxygen, and his doctors feared he wouldn’t survive. They still had no idea what was causing his symptoms.

By this time, the boy had grown delirious and begun screaming and crying. A nurse tried to console him, but he told her he had to go home right away, that Toby would be missing him. When she asked who Toby was, he replied, “Toby is my pet rat. He’s my best friend, except when he bites. Nobody is looking after him!”

Alec’s nurse was unable to stop thinking about what he’d told her. She returned to the ward later that night and asked the boy if he’d been bitten recently. Alec said he had, while cleaning his pet’s cage two weeks earlier, and that he’d already informed the doctor. There, on his right forearm, was a small infected mark. Within hours, a microbiologist ran another round of tests on samples of Alec’s blood and urine, which revealed he had Weil’s disease.

WEIL’S DISEASE is caused by a bacterium called Leptospira. Although rats are the most common carriers, the pathogens are also found in goats, cattle, dogs and gerbils (none of which display any outward signs of the condition). The infection usually causes a mild flulike illness. In about ten per cent of cases, however, it may progress to multi-organ failure and can be fatal, says Dr Stuart Whitelaw, who was involved in the boy’s treatment.

“Alec’s case shows the importance not just of taking a full medical history, but also of noting the most fragmentary, seemingly unrelated, pieces of information,” Whitelaw says. “Something that appears irrelevant at the beginning may turn out to be the very factor that saves the patient’s life.”

The Leptospira bacterium can be detected in the blood only in the first seven to ten days of the infection, he says, so if they’d lost one more day, the results would likely have come back negative and the diagnosis would have been missed. “If Alec’s condition had deteriorated any further, he’d have been treated with a dialysis machine and put on an artificial ventilator – and he wouldn’t have been able to tell the nurse that he’d been bitten by a rat.”

Once the doctors realised Alec had Weil’s disease, his antibiotic treatment was switched to high-dose penicillin, and his condition improved immediately. Within days, Alec made a full recovery and was able to go home to take care of Toby. He now has a lifelong immunity to that particular strain of the infection, though he may be susceptible to other variants.

If the doctors had lost one more day, they likely would have missed the diagnosis