Allogeneic bone marrow transplantation is one of the important means to treat certain types of leukemia. This treatment process mainly uses bone marrow mobilization agents to promote the donor's hematopoietic stem cells to enter the blood. Then, blood collection is performed in a smaller amount than ordinary blood donation.
Separate it with a centrifuge, extract about 10 ml of hematopoietic stem cell solution, and then inject it into the recipient through intravenous injection. This hematopoietic stem cell solution is actually a blood product. And blood products, of course, may spread various
of a disease.
"According to general principles..." Dr. Pascal frowned and thought for a long time. "There should be no infection in bone marrow transplantation."
General allogeneic bone marrow transplantation usually occurs among relatives of the recipient, and most of them are immediate relatives. Some unlucky patients may not be matched with relatives. At this time, hematopoietic stem cell donation is needed to treat the disease. Bone marrow
The mobilization agent requires continuous injections for at least four days. From the moment the donation is confirmed, the donor must undergo a considerable number of disease tests to ensure that the donated hematopoietic stem cells will not cause the spread of disease. Moreover, even if there is any newly infected disease
, during the four-day mobilization injection process, the donor will show some signs.
"What about non-general principles?" Sun Lien also knew that inspection before donation is very important and very strict. But this does not mean that there will not be some non-human omissions. After all, accidents are unexpected.
"There may be some pathogens spreading from unconventional inspection items?" When it comes to this, Dr. Pascal is not sure. He just made a guess based on his own research experience and research direction. "There may be some unconventional inspection items."
It’s a virus with specific antibodies and no specific symptoms, right?”
Sun Lien rolled his eyes. There are no specific antibodies and no specific symptoms. If there is such an infectious disease and it can behave like Yang Jianqiang, then all doctors and medical scientists can wash their necks and wait for the doctors to die.
How excited you are when you encounter a rare case, you can roughly know it by looking at the medical record reports in the journals published every month.
However, there is indeed nothing wrong with Dr. Pascal’s inference. Without specific antibodies, it is possible to bypass pre-donation examinations. Without specific symptoms, it is possible for donors and doctors to ignore the symptoms at the same time. If Lin Jianqiang’s current cause is from
For donated bone marrow, only pathogens that meet both conditions are possible.
"The MRI results are out." The two people were staring at each other at the door. Liu Pingchuan walked out of the room with the newly released MRI image. His brows were deeply furrowed, and there were layers of furrows in the middle of his white eyebrows. "
Xiao Sun, come and take a look at this."
Those eight edema areas were obvious on MRI, and the most noticeable one was the edema area near the basal layer. Although it looked a little blurry, it was indeed an approximately round gray spot.
"MRS shows that the metabolic level of Cho increases, while the metabolic level of Naa decreases." Liu Pingchuan estimated that Sun Lien could only watch the excitement, but could not see the specific way. So he explained, "CHO represents the degradation product of myelin and is related to the maintenance of myelin.
It is related to the integrity of chemical metabolism. The decrease in naa metabolism level indicates damage to brain cells."
"There have been such big changes from early to now..." Sun Lien frowned and asked, "Could it be herpes simplex encephalitis?"
Herpes simplex encephalitis is a relatively common type of viral infection encephalitis, and its biggest feature is its rapid progression. But this conjecture was denied by Dr. Pascal, "Herpes simplex encephalitis starts in the temporal lobe, and this patient has multiple attacks. And there are no
Symptoms of cerebral gyrus edema appear.”
"What about cryptococcal infection?" Dr. Pascal asked after pondering for a moment, "This infection has a hidden onset..."
"There are no soap bubble cysts." Liu Pingchuan also joined the discussion. "And the cryptococcus will not be invisible. The morning examination will not show changes so quickly."
"So, there are three things we need to understand now." Sun Lien began to make a summary. "First, why the disease progresses so quickly. Second, what is the cause of his current symptoms. Third, brain cells
Whether the damage and multiple edema are direct manifestations of the disease he suffers from."
Pascal nodded thoughtfully. The first two questions raised by Sun Lien were very simple and direct, but the third question had some profound meaning. If you think blindly in terms of infectious diseases, you may misunderstand some of them.
Autoimmune diseases with insufficiently obvious characteristics are misdiagnosed as infectious diseases. Considering that the patient's condition changes after adjusting the immunosuppressive regimen, this possibility also needs to be taken into consideration.
"First use mannitol to lower the brain pressure." Sun Lien shook his head. He originally thought that this imaging examination could provide some direct clues to assist in diagnosis, but he did not expect that after going around in a circle, the diagnostic ideas returned to the original state.
Reached the starting point.
The current plan... we can only stabilize the patient's condition first. Sun Lien looked at Yang Jianqiang who was pushed to the emergency room again, and suddenly felt a little irritable.
Being a doctor is actually just about this. The salary is not high, and it is very tiring. It is common to be misunderstood and wronged by patients. And what makes doctors feel that their work is meaningful... is actually diagnosing difficult and complicated diseases in patients.
, cured the fatal disease.
Saving a life, and then gaining a sense of self-satisfaction. This is the main motivation that supports most doctors to work exhaustingly every day.
But now... it seems that it has become difficult to obtain this motivation. Sun Lien is not only a little irritable, but even feels a little angry.
"What should we do next?" After calming down for a while, Sun Lien asked Dr. Pascal, "Do you have any suggestions?"
"I think..." Dr. Pascal thought for a while and put forward his own idea, "Let's do a blood and cerebrospinal fluid PCR test."
"What items to check?" Sun Lien asked with a frown. PCR testing is generally a testing method used to verify pathogen guesses. Performing PCR testing when there is not even a reliable guess is purely to prepare for finding faults and inspections.
A means of provoking a fight.
"Let's first check for common infections after bone marrow transplantation." Dr. Pascal spread his hands. "Parasites that can cause central nervous system symptoms include strongyloidiasis and toxoplasmosis. For viruses, vzv (herpes zoster)
Viruses) we have just ruled out. The course of ebv (epstein-barr virus) is not so fast. Polyomavirus (jc polyomavirus) seems to be the most likely at present."
"Progressive multifocal leukoencephalopathy?" Liu Pingchuan understood the direction of Dr. Pascal's guess. "This disease is very rare."
"But we can predict the changes in cho metabolites, and the onset is also subacute." Dr. Pascal seemed very confident in this guess. But then his slightly excited expression cooled down again, "But...
…The prognosis of this disease is not good.”
It’s not just bad, it’s simply too bad. So far, there is no effective treatment for progressive multifocal leukoencephalopathy caused by jc polyomavirus. Ordinary antiviral treatments are very ineffective against jc polyomavirus.
, the only way to improve symptoms is to enhance immunity.
For Yang Jianqiang, if he is really infected with jc polyoma virus, it is basically a death sentence. Strengthening immunity will trigger an inflammatory storm, and then he will die. Without strengthening immunity, jc polyoma virus
If it continues to progress, more and more of the brain's white matter will be damaged, and he will still die.
"This..." Sun Lien held his breath in his chest. He really didn't expect such a result. After holding it in for a long time, he sighed and suggested, "Let's check them all. I hope it's not JC."
Liu Pingchuan wanted to go to the emergency room to have a breather with Zhou Jun, and to explain the patient's condition to Zhou Jun was naturally taken over by Vice President Liu. Dr. Pascal returned to the outpatient clinic with a melancholy look on his face. Sun Lien stood alone in the video
At the door of the department, he crossed his arms and began to think deeply.
Dr. Pascal's diagnosis was very clear, and he narrowed the initial suspects to two parasites and a virus. Experienced doctors are indeed much better than Sun Li'en, a fool. But the fool is not
I vaguely feel that something is not quite right in the narrative just now.
According to Dr. Pascal's explanation, JC polyomavirus mainly affects the brain, but the onset is mostly chronic or acute. If Yang Jianqiang's onset is calculated from the time of blurred vision, there is no problem in counting it as a subacute onset. But
Imaging examinations have proven that Yang Jianqiang's condition suddenly accelerated today. If we follow this logic, the diagnosis of JC polyoma virus seems somewhat untenable.
Moreover, the imaging characteristics did not seem consistent. Sun Lien thought of the imaging examination results he had just seen. The eight edema areas were relatively scattered, but most of them were located at the junction of gray matter and white matter.
Since the disease caused by JC polyomavirus is called "progressive multifocal leukoencephalopathy", it is thought that the main affected part should be the white matter of the brain, not the junctional area.
But if it weren't for jc... Sun Lien's eyes suddenly widened.
"Before we met...Old Yang should have raised a dog." "He said that his grandma had raised a white cat before. A big white cat with blue eyes. It was very beautiful. But it was almost thirty years old.
It happened years ago.”
The patient had a history of close contact with cats and dogs! There was a bang in Sun Lien's mind. He suddenly felt grateful for his trip to the Capital Tongxie. If he hadn't seen Tongxie's case writing skills, he would not have discovered it so easily.
The connection here. Only by recording all the information in detail can we find the basis and answers for diagnosis!
Sun Lien's diagnosis was that Yang Jianqiang suffered from cerebral toxoplasmosis. But his cerebral toxoplasmosis did not come from bone marrow donation, but from eggs that had been lurking in his body for a long time. He had cerebral toxoplasmosis.