Zhaxi now deeply understands that an excellent doctor must learn to check English literature in order to learn from the experiences of doctors worldwide.
He closed his notebook, looked at the clock; it was already 6 PM. He stood up, holding those papers, and walked to Professor Yang’s office. Professor Yang hadn’t left work yet.
He was examining an MRI scan; seeing Zhaxi enter, he put down the scan: "Found anything?"
Zhaxi placed the papers on the table and began his report. He detailed all the information he had gathered, his analysis process, and reasons for excluding other diagnoses. Finally, he reached his conclusion: "Professor Yang, I suspect this patient has an autoinflammatory disease, possibly an atypical presentation of adult Still’s disease or an unclassified autoinflammatory syndro. I suggest a whole-body PET-CT scan to rule out potential tumors and infections. anwhile, check serum ferritin and glycosylated ferritin — adult Still’s disease patients usually have significantly elevated serum ferritin and decreased glycosylated ferritin ratio. If the ferritin is markedly elevated, it supports the diagnosis."
Yang Ping listened, without speaking imdiately, and then browsed through the literature, page by page. After finishing, he dialed Director Liu’s mobile phone.
"Director Liu, hello, regarding the patient in bed 15, I suggest checking serum ferritin and glycosylated ferritin. Yes, and a whole-body PET-CT. Okay, thank you."
After hanging up, he looked at Zhaxi: "As before, when the results are out, you do the analysis."
Zhaxi nodded.
Three days later, the test results gradually ca out. Serum ferritin was 1500 ng/mL, the normal range being 20 to 200. The glycosylated ferritin ratio was 20%, with the normal range above 50%. The ferritin was significantly elevated, and the glycosylated ferritin ratio significantly decreased. This is a typical presentation of adult Still’s disease. The PET-CT also ca back, showing no evidence of tumors or infections. There was no abnormal tabolic activity throughout the body, only mild splenogaly.
Zhaxi took these results to Yang Ping. After reviewing them, Yang Ping nodded: "The diagnosis is clear, adult Still’s disease involving the central nervous system. It seems you’ve learned to check the literature; now that the diagnosis is clear, let’s proceed with the treatnt."
Zhaxi revealed his treatnt plan: "Glucocorticoids, thylprednisolone pulse therapy, followed by a slow tapering of oral prednisone. If the effect is poor, IL-1 antagonists, like Anakinra, or IL-6 antagonists, like Tocilizumab, can be added."
"Did you notice that glucocorticoids can be used in many scenarios, and in so they are the only option? An excellent doctor must master the use of glucocorticoids," Yang Ping reminded him.
Zhaxi continued to manage this patient, assisting as the primary doctor in the Neurology Departnt.
Every morning, he did ward rounds, as before, asked about changes in the illness, perford physical exams, and docunted the disease progress. He reviewed a vast amount of literature, learning comprehensively about the etiology, pathology, diagnosis, treatnt, and prognosis of adult Still’s disease. This ti he also learned how to interpret PET-CT scans of this disease, assessing the size and tabolic activity of the spleen.
The treatnt was very effective; three days after thylprednisolone pulse therapy, the patient’s temperature returned to normal. A week later, joint pain significantly reduced, and the rash subsided. Two weeks later, consciousness completely returned. As he was discharged, he held Zhaxi’s hand and said, "Doctor Zhaxi, thank you. I finally know what illness I have."
Zhaxi smiled: "You’re welco, it’s our duty."
User Comments
0 comments from readers