The system takes me for surgery

The clinical manifestations of early Kawasaki disease are not typical, and there are no specific laboratory diagnostic indicators, the misdiagnosis rate is high, and it is very easy to be misdiagnosed as a common cold, resulting in missing the best treatment period.

In the emergency room, Hong Chenyu thought it was a common cold, but the medical staff working in the emergency room are naturally alert, especially the elderly and children.

If the family members are willing to be hospitalized for observation, that is what everyone wants to see the most, and it is good for both the patient and the doctor.

Director Li thinks that it is obviously in line with the diagnosis of Kawasaki disease in the early stage. Everyone has a feeling of enlightenment and enlightenment. They think that these symptoms are very close to Kawasaki disease, why can't they think of it.

With the diagnosis result, the next step is to treat according to this diagnosis as soon as possible.

Director Li issued a doctor's order to give the child intravenous immunoglobulin and oral aspirin.This is the standard treatment for early Kawasaki disease, which can improve the inflammatory state and autoimmune response. While aspirin is antipyretic and analgesic, it can also inhibit platelet aggregation and reduce the cardiovascular risk of iKD.

Theoretically speaking, the treatment methods that have been given to children in a timely manner and to the cause should have a significant effect in the short term.However, after more than 36 hours of treatment, the boy still had nocturnal fevers.

Is the dose not enough?
Director Li frowned, and prescribed another dose.

However, although the child is still in a state of fever, laboratory indicators show that his laboratory test results seem to have improved, and it seems that he has seen the light of day.

As the treatment progressed, something unexpected happened.

The child's cell counts did not stabilize after reaching normal levels. Within 24 hours, the little boy's anemia became more and more serious.Transaminase levels also deteriorated rapidly, and ferritin levels soared to unimaginable heights.

To make matters worse, fibrinogen levels began to decrease, and prothrombin time and partial thrombin time began to increase, suggesting that a persistent inflammatory state or unknown primary disease was affecting the child's coagulation function.

The child began to lethargy, the rash worsened, and the high fever persisted.

The family members began to have opinions, because the little boy came to the hospital well, and after being treated by doctors, not only did not relieve, but he fell into a coma.

The diagnosis of Kawasaki disease seemed to be a bit untenable, and Director Li's heart was beating. The boy's various laboratory indicators later proved that his diagnosis was wrong.

An old doctor with more than [-] years of experience was a little caught off guard when encountering such a situation. He hurriedly combined several departments to hold a general consultation, and gathered together several senior doctors from the Department of Hematology, Department of Infectious Diseases, and Department of Endocrinology. up.

Everyone shook their heads, thinking that from the analysis of the symptoms, it was Kawasaki disease, but the effect of the treatment was still in front of the little boy's current physical condition.

Director Li finally called Zhou Aimin from the diagnostic department and asked him to come to the consultation.

In fact, Director Li of the Department of Pediatrics is still at work with his inherent thinking. In his opinion, a doctor who can't even make a diagnosis is still a doctor, and he knows how to consult, so why add an inexplicable diagnostic department?

After receiving the call, Zhou Aimin collected the little boy's medical records, medical history and examination materials into his own hands through computer data.

When he came to the pediatrics office, Zhou Aimin kept talking about: persistent fever and rash, enlarged lymph nodes, hepatosplenomegaly, lethargy, pancytopenia, decreased ESR, liver function damage, abnormal blood coagulation function, high ferritin level to the ceiling...

The doctors who came to the consultation department thought he was doing something,
Zhou Aimin suddenly saw a buoy in his ocean of knowledge, and that was it.

It's SoJIA!

When I heard this conclusion, the doctors who were not very optimistic about Zhou Aimin before began to disagree with several consulting doctors. Hematology and pediatrics believed that he was right.

Infectious Diseases and Endocrinology thought his diagnosis was wrong.

In the end, Director Li of the Department of Pediatrics made the decision to give the little boy intravenous methylprednisolone and anakinra according to Zhou Aimin's diagnosis!

Within 48 hours of starting treatment, the child's fever symptoms began to decrease, and laboratory test results gradually improved.

After several days of treatment, the child was discharged from the hospital smoothly, and went home to continue oral administration of prednisone and anakinra.

The disease diagnosis this time strongly proved that Zhou Aimin played a huge role in the diagnostic department. The dean Xiang Hongzhi was also very happy and asked Zhou Aimin to explain the case in detail to the doctors who had previously consulted and the internal medicine department.

Zhou Aimin also did a lot of preparatory materials, and finally he believed that the real diagnosis of this child was macrophage activation syndrome (MAS).

MAS is a severe and potentially fatal immune phenomenon characterized by hyperactivation and proliferation of macrophages and T cells.It is closely related to hemophagocytic lymphohistiocytosis, and both are similar diagnoses. It is often caused by genetic factors or certain malignancies. MAS is often described as a secondary form of HLH that often occurs in patients with underlying rheumatic disease.

Although MAS may occur in patients with Kawasaki disease, as the disease progresses, Zhou Aimin's diagnosis may actually be SoJIA. Due to many common features, it has been misdiagnosed.

In fact, it also exposed that such a complex diagnosis has shortcomings in various clinical specialties, and it is easy to be misled by inherent thinking.

In the diagnostic department, all previous habitual thinking is cleared, and more objective thinking is used to derive conclusions with clinical evidence.

In the emergency department, he was mistaken for an atypical cold, and in the pediatric department, he was misdiagnosed as incomplete Kawasaki disease. The boy's disease manifested as MAS, but the final diagnosis was SoJIA.

This is also the first time that the diagnostic department has played a practical clinical role in the affiliated hospital.

Liang Yi also went to this class, and he was very absorbed in it. Zhou Aimin often lectured during his doctoral period and has considerable teaching ability. Liang Yi thinks that the affiliated hospital with such a learning atmosphere has a promising future!
The affiliated hospital also wrote the medical record in the form of words and pictures in its own hospital self-media, and wrote the whole diagnosis process in a realistic and realistic way.

After seeing the news, Zhou Fusheng, the dean of the general hospital, thought it was a gimmick, and after sending people to inquire about it, he found that the affiliated hospital had really set up a diagnostic department.

The article in this medical record is not enough to prove how much the overall level of the affiliated hospital has improved, but it proves that what Liang Yi said before is being realized one by one, and it also proves how much the director of the affiliated hospital Xiang Hongzhi values ​​​​Liang Yi. Indistinctly such changes are just the beginning.

This made Zhou Fusheng, who had been in charge of the general hospital for more than ten years, feel a sudden pressure in his heart. He couldn't figure out why a small resident doctor would mess up his mood...