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Wednesday, May 13, 2009

SLE/ MISDIAGNOSIS AND COMPLICATIONS

Posted by Prahallad Panda on 6:56 PM Comments


It was only an alert to me some 18 years back that my brother-in-law was suffering from dry fever for about 5 to 7 days.At that time I was in a primary health center in a tribal belt of Orissa,India and recently completed my graduation trying for post graduation.Again after 4 to 5 days message came that the fever was continuing in spite of treatment for common causes of fever .One of them prevalent in the area was malaria.So I reached their place traveling about 200 Kms.I saw him and except dry fever no other symptom or sign was discovered and was on anti-malarial therapy. Hoping a recovery I returned to my PHC to receive again a message that there had been no remission.So I suggested hospitalization in the SCB medical college,Cuttack some 40 Kms from his place and reached straight there.My co-brother from Tatanagar also joined so also other relatives.My teachers were there and all relevant investigations for fever that has crossed the dead line of 6 weeks to be labeled as fever of unknown origin were being carried out.Only some non specific minor abnormalities were discovered without significant contribution towards a correct diagnosis.
Again some presumptive treatments given and he was discharged from hospital to come back again some 4 to 5 days later.In the meanwhile I got transferred to a nearer place to the medical college . By this time he had developed collection of fluid out side his lungs in the chest.The common diagnosis for this condition in this part was uberculosis and treatment starts without waiting for other confirmatory investigations.The fluid aspirated was bloody in nature giving a suspicion of cancer and was sent for cellular test to two different pathological labs.
Both the places reported that to be oat cell carcinoma of lungs a dreaded one having poorest prognosis.We were shocked.He was married only 3 to 4 years back blessed with a girl child.
The suggestion came up was to take him to one of the best center for cancer research and treatment in Mumbai(Bombay then) The Tata Memorial Center.We travelled more than 1000 Kms in a much pitiable condition to reach there.There the clue, the collected fluid was tested again and to much relief no cancer cells were found .So the cancer diagnosis was abandoned and once again search continued for a diagnosis. Presumed to be tuberculosis anti-tuberculous drugs continued which had already been started.One thing that was done there was addition of steroids.
Much to our relief the fever subsided slowly and we were happy.But our happiness did not last long as fever again re-appeared when the dose of steroid was tapered to be stopped finally.But one thing came up is that the disease was steroid responsive and the commonest was one of the collagen diseases.But all available common investigations at Cuttack had already been exhausted.So he was shifted to Tata Main hospital ,Jamsedpur ,my co-brother's place where the antibody against double stranded DNA was tested positive branding it again a bad disease, Systemic Lupus Erythematus.And steroid was the drug of choice.Then we could co-relate how the fever subsided with addition of steroid at Mumbai to anti-tubercular drugs .
He did well for some years ,there after only to damage the ligaments at knee joints which were repaired.Again he developed steroid induced cataract in both the eyes to get operated for.A long time passed, to our misfortune SLE activity flared time and again to be suppressed by increasing doses of steroid.Finally immune suppressant chemotherapy was added and he is doing fine till date.He is under the treatment of Dr Roy of Tatamotors hospital at Jamsedpur.
This live story describes in a nutshell how a disease can behave in an atypical manner, can be mis-diagnosed as cancer , the complications of disease and treatment , the relapses and control .


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