Med­i­cal Mys­tery: What’s Wrong With Me?

Reader's Digest Asia Pacific - - Health - BY SYD­NEY LONEY

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

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