Med­i­cal Mys­tery

Reader's Digest International - - Contents - BY SYD­NEY LONEY

THE PA­TIENT: Ted* a public sec­tor worker in his late 40s

THE SYMP­TOMS: Low-grade fever, per­sis­tent cough and fa­tigue

THE DOC­TOR: Dr. Neil Shear, head of der­ma­tol­ogy at Sun­ny­brook Health Sciences Cen­tre in Toronto, Canada

FOR THREE WEEKS last Fe­bru­ary, Ted strug­gled to ban­ish what he thought was a nasty flu bug. He had a dry cough, a fever of 38 C and a feel­ing of fa­tigue that eight hours of sleep— and over-the-counter cold med­i­ca­tions—couldn’t fix.

Fi­nally, fed up with feel­ing lousy, Ted went to his fam­ily doc­tor, who dis­cov­ered puz­zling sores the size of small warts inside his mouth and nose and re­ferred him to the in­ter­nal medicine clinic at Sun­ny­brook Hospi­tal in Toronto. The physi­cian there sus­pected vas­culi­tis, in­flam­ma­tion in the veins and ar­ter­ies that of­ten presents with fa­tigue, cough­ing and skin sores.

It was now April, three months af­ter Ted started feel­ing sick, and his health quickly de­te­ri­o­rated: his cough wors­ened and he was so tired he could barely make it through his work­day. He’d also lost his typ­i­cally healthy ap­petite and was drop­ping weight. More trou­bling: the le­sions in his mouth and nose were get­ting larger, and had spread to his throat.

Ted was re­ferred to an oral sur­geon, who biop­sied the le­sions in his mouth. The re­sults were read as gran­u­lo­ma­tous vas­culi­tis, align­ing with the in­ternist’s ear­lier sus­pi­cions. This vari­ant typ­i­cally in­volves the up­per res­pi­ra­tory tract—an X-ray re­vealed a fuzzy shadow in Ted’s lungs. The

dis­ease af­fects about one in 25,000 peo­ple, of­ten in their 40s and 50s, and may lead to heart dis­ease and kid­ney dam­age. While the con­di­tion can be very se­ri­ous, when it’s di­ag­nosed and treated promptly, the cur­rent sur­vival rate is about 90 per­cent.

Un­for­tu­nately, two weeks of tak­ing cor­ti­cos­teroids to con­trol in­flam­ma­tion and sup­press his im­mune sys­tem didn’t re­lieve Ted’s symp­toms. The le­sions had spread to the skin on his arms, legs and torso, and the ab­scesses in his mouth and throat made it dif­fi­cult to eat or talk. By this point, it had been al­most six months since the on­set of his ill­ness, and Ted had lost hope of ever get­ting bet­ter. Be­cause the sores on his body were so dis­fig­ur­ing, he was re­ferred to der­ma­tol­o­gist Dr. Neil Shear.

Shear took one look at the pa­tient and knew he didn’t have vas­culi­tis. “Once you see a con­di­tion like this, you don’t for­get it,” he says. What Shear saw was blas­to­my­co­sis, an air­borne fun­gal in­fec­tion that orig­i­nates from mould that grows in damp soil and de­com­pos­ing leaves. It’s found in the U.S. and Canada, as well as parts of India and Africa, and af­fects peo­ple (and an­i­mals) who breathe in the spores, though not ev­ery­one who’s ex­posed will de­velop the in­fec­tion.

Flu-like symp­toms typ­i­cally ap­pear one to three months af­ter a per­son in­hales the fun­gus. Once the micro­organ­isms en­ter the lungs, they trans­form into a yeast that spreads through the blood­stream. “Even­tu­ally, the pa­tient would have been on a ven­ti­la­tor and likely would have died,” Shear says.

Blas­to­my­co­sis is un­com­mon in many re­gions, and Ted is still un­sure where he picked up the ill­ness. Ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, yearly in­ci­dence rates in the U.S. are ap­prox­i­mately one to two cases for ev­ery 100,000 peo­ple. Shear says the in­fec­tion is of­ten mis­di­ag­nosed be­cause it so closely re­sem­bles the flu. When re­view­ing biopsy re­sults, it’s help­ful to know what to look for, he says.

In Ted’s case, the fun­gal el­e­ments were noted but weren’t per­ceived as be­ing sig­nif­i­cant. “It can take a lit­tle ex­tra de­tec­tive work.”

For­tu­nately, the con­di­tion is treat­able. Al­though Shear per­formed a sec­ond biopsy and fun­gal cul­ture, he didn’t wait for the re­sults to start a reg­i­men. He promptly pre­scribed a high dose of an­ti­fun­gal med­i­ca­tion two times a day for a month. “Af­ter a week, the pa­tient started get­ting bet­ter,” Shear says. To­day, Ted has fully re­cov­ered.

“Once you see a con­di­tion like this, you don’t for­get it,” says Dr. Neil Shear.

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