I can see the status bar

Chapter 659 Induction (8 August 27th for subscription)

"Continue the CRRT treatment, let go of the immunotherapy first." Sun Lien returned to the office, and after correcting his instructions, he whispered to Dr. Pascal, "Old Pa, come out with me."

"What's wrong?" In the office of the director of the Comprehensive Diagnostic Center, Dr. Pascal handed Sun Lien a cup of hot cocoa, "You don't look very pretty."

Sun Lien sat on the sofa and rubbed his face, trying to organize his words.But he soon found to his dismay that he couldn't find a suitable interface to ask questions to immunology experts.

Why this contradictory explanation for the status bar?Why is an SLE patient with an onset of at least 8 points considered quiescent?There are too many questions in Sun Li'en's mind, but there is no way to ask them.

"I..." Sun Lien took another sip of hot cocoa, he sighed and asked, "I feel something is wrong."

"Feeling?" Dr. Pascal frowned slightly. He rubbed his ginger-red hair, pondered for a while and asked, "Is it right for the diagnosis?"

"I can't tell." At this point in the play, you can't suddenly put down the glass and leave.Sun Li'en bit the bullet and continued to perform, "I always feel...his SLE and the course of the disease are a bit inconsistent—although the diagnosis of SLE should be correct."

"50% of patients will show kidney damage or renal insufficiency in SLE." Dr. Pascal seemed to attach great importance to Sun Lien's "feeling wrong", and he tried hard to analyze what might go wrong. "It's no problem that the vasculitis caused three-vessel lesions, after all, his blood lipids are not high."

"If it's vasculitis caused by SLE..." Sun Lien keenly grasped a point that might lead to a topic, "It should be systemic, right?"

The vasculitis caused by systemic lupus erythematosus does not have a predilection area. It can involve blood vessels in many locations—in more cases, lupus vasculitis appears on the body surface and extremities.A large number of immune complexes can deposit and block the tiny blood vessels at the extremities of the limb, and cause gangrene or simply death of the limb.

But Wang Ge's body surface is normal, and there is no sign of vascular disease at all.

"He also didn't report that he had Raynaud's reaction, no limb pain...he didn't have any symptoms of vasculitis." Sun Lien said more and more, his train of thought became smoother, "His immune complex is so smart, it only blocks his coronary artery? It doesn't make sense."

"This is indeed suspicious, but it is not impossible at all." Dr. Pascal nodded, then shook his head again, "Systemic lupus erythematosus is a very strange and changeable disease. Although its general lesion direction is different Pretty much the same, but the exact symptoms are very different. And everyone is different, maybe there is something else that makes this patient's coronary arteries more prone to blockage—like a congenital malformation?"

"Contrast imaging has been done, it's normal." Sun Lien continued to reason his thoughts, he had to let Dr. Pascal realize that there was something abnormal about the situation. "And this renal insufficiency is also questionable. If he really has lupus vasculitis, then the possibility of him developing lupus nephritis is about 80%-kidneys are very sensitive to blood perfusion and autoimmune system diseases. In In this case, his kidney damage seems to be showing up a little too slowly."

Dr. Pascal was successfully diverted by Sun Lien.He also began to hesitate, "This...is really a bit strange."

"It's because of this that I've always been a little uneasy." Sun Lien breathed a sigh of relief, and he finally said the most important thing, "The patient's C3C4 complement is low, antinuclear antibody is positive, proteinuria, and the diagnosis of systemic lupus The criteria match three. There is basically no problem in diagnosing systemic lupus erythematosus. But now his symptoms and course of disease are not in line with SLE."

This is where the contradictions arise.Lupus in quiescence does not cause these symptoms.

"That means..." Dr. Pascal and Sun Li'en said in unison, "There are other problems causing these symptoms!"

"What disease can cause coronary artery inflammation, proteinuria, and...mental symptoms at the same time?" Sun Lien thought about it, but still added the mental symptoms.He really didn't think that a national first-level barbarian could find a girlfriend—and still have such a good relationship.

Dr. Pascale pondered for a while, "If you want to ask me, my answer is Wegener's granulomatosis."

Wegener's granulomatosis is the old name for granulomatous vasculitis, an autoimmune disease.The lesion occasionally involves the large arteries and mainly affects the upper and lower airways and kidneys.At the same time, this disease can also cause neurological lesions.

"Very few patients with Wegener's granulomatosis initially present with psychiatric symptoms, but about a third of patients develop neurologic disease as the disease progresses - although peripheral neuropathy is most common, central nervous system involvement does occur This may lead to mental symptoms." Dr. Pascale took a sip of coffee, "If it is Wegener's granulomatosis, the patient is likely to have the same oral and nasal symptoms as SLE... This diagnosis is troublesome."

The symptoms of SLE with less typical symptoms and granulomatous vasculitis overlap highly, because they are both autoimmune diseases, and even their biochemical characteristics are basically the same.There are not many ways to completely distinguish between the two.This also makes it extremely difficult for most patients with granulomatous vasculitis to be diagnosed - the average diagnosis time for this disease is as long as 5-15 months, and even 10% of patients need 5-10 years to be diagnosed .

"Give him a CT scan to see if there are any lesions in the lungs, and then take samples from the kidney and bronchial lining for biopsy." Sun Lien made a decision, "I'll ask about the ulcer again..."

"You need to adjust your treatment plan a little bit at the beginning." Dr. Pascale added, "For patients with Wegener's granulomatosis, it is very necessary to start treatment early. The sooner they start hormone and immunosuppressive therapy, the sooner they The longer the survival time - without systemic treatment, the prognosis of this disease is poorer."

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"Ulcer? I have it now." In the ward, Wang Ge answered directly after hearing Sun Lien's question, "I saw it when I looked in the mirror yesterday, but it didn't hurt."

Sun Li'en looked at Wang Ge's parted lips, it was indeed an ulcer. "Have you ever been in a similar situation before?"

"Didn't you spy on me? Don't you know?" Wang Ge, who just cooperated a little bit, fell ill again. "You don't know anything. Why are you asking me?"

"Stop messing around!" This time it was Wang Ge's girlfriend who couldn't listen anymore, "Why are you talking to the doctor?"

"Oh, urgent?" Wang Ge still looked indifferent, "It's just an ulcer, look at you like this, what can it do?"

Sun Li'en coughed lightly, and said to Wang Ge's girlfriend who looked shocked and disbelieving, "He...wasn't like this before?"

"I've never seen him like this." Wang Ge's girlfriend shook her head and replied, she looked very disappointed, "I just went abroad for an exchange, and it's only been three months. He... he just became like this. "

(End of this chapter)