28-year-old Ningbo girl Xiaowan (pseudonym)
One month after giving birth to the second child
High fever does not go away
Lung lesions are like "guerrillas"
In the left and right lungs "channeling" to "channeling" to go
COVID-19?
Infectious pneumonia?
Organic pneumonia?
Antibiotic therapy
Add hormone therapy
Treatment for almost a year
Lung lesions are still "guerrilla" everywhere
What happened to XiaoWan?
Zhejiang expert: She herself is "killing" herself
Fortunately, the child was not "killed"
？？？
What kind of horror suspense story is this?
One month after delivery
Is she sick?
Xiao Wan, 29 years old, from Ningbo. From the age of 28 to 29, she went in and out of the hospital uncountably. At the age of 28, Xiaowan gave birth to a second child, and since then she has entered a new life with both children and daughters.
“39℃。” Not long after the second child was born, Xiaowan inexplicably developed a high fever, accompanied by mild chest pain. "Is it blocking the milk?" Xiaowan's friend said on WeChat that because Xiaowan returned to milk from the birth of the child, the child was fed pure milk powder, so there was no milk blockage leading to fever.
“39.5℃。” The fever lasted for a day and a night, Xiaowan walked into the local hospital in Ningbo, the new crown virus nucleic acid negative, lung CT showed that there were lesions in the left lower lung, the inflammatory indicators were elevated, consider infectious pneumonia, antibiotic treatment.
After using the antibiotics for a while, the CT of the lungs was reviewed, and the original lesion disappeared. Originally thought that infectious pneumonia had been cured, who knows not long, high fever, chest pain killed back to the carbine.
"There are lesions in the upper left lung." The same examination, but the lesion ran from the bottom of the left lung to the upper side, the inflammation was still there, and the local hospital in Ningbo recommended continuing antibiotic treatment.
The lesion is gone and there is, from the upper left lung even to the right lung, but also the right lung to "swim" over and over again, can be described as very naughty and "psoriasis".
"You've gone from ordinary infectious pneumonia to organic pneumonia." Mechanized pneumonia is a pathological change of unknown alveolar inflammation caused by various etiologies, and is commonly characterized by recurrent and wandering shadows. Therefore, in addition to antibiotic treatment this time, drug treatment also added glucocorticoids, in general, clinically glucocorticoids have a good effect on the treatment of mechanized pneumonia.
After three months of hormone therapy, the lung lesions are still fighting guerrilla warfare.
Since the full moon of the second child, I have been dealing with the lesions of the lungs, and now the second child is almost one year old and continues to deal with.
"Let's go to Hangzhou University Hospital again." Xiao Wan already wanted to go to the first hospital of Zhejiang University to see it again, if there was still no way to completely cure the lesion, she planned not to cure it, "Isn't it just an occasional chest pain, and you can't die." To this end, she walked into the expert clinic of Zhou Hua, chief physician of the Department of Respiratory Medicine of the First Hospital of Zhejiang University.
Pulmonary embolism is suspected
But evidence is hard to find
"The pathological results of the puncture show necrosis in the lungs, but I can basically determine that this is not organic pneumonia." Chief Physician Zhou Hua combined Xiaowan's situation and related examination results, and he ruled out various possibilities one by one, the first of which was organic pneumonia.
Chief Physician Zhou Hua explained that the pathological result of mechanized pneumonia is the presence of granulomas, because mechanized pneumonia is an unexplained inflammation, inflammation will lead to the growth of granulomatous tissue in the lungs, if Xiaowan's year-long lesion is caused by mechanized pneumonia, there must be granulomas, the most critical is that mechanized pneumonia generally does not appear tissue necrosis.
"You don't support vasculitis either." Director Zhou Hua said that Xiaowan's examination results showed that the indicators related to vasculitis were negative, and it was obviously not caused by inflammation of the blood vessels in the lungs.
"I feel like a pulmonary embolism." But strangely, pulmonary CT angiography did not find pulmonary embolism, and Chief Physician Zhou Hua asked Xiaowan not to worry, he wanted to do further and more detailed examination to verify his conjecture. Dr. Chen Jun, a physician in the Department of Respiratory Medicine, has been soothing Xiao Wan's uneasy emotions, telling her that only by finding the "root" can she carry out treatment.
"We have never seen a necrosis like this." After learning of Zhou Hua's thoughts, Chief Physician Sun Ke of the Department of Pathology said that this necrosis was different from that caused by previous bacterial infections. What's the difference? Let's make an analogy, the puncture out of the thing as a house, the past necrotic pathology is the house frame with the furniture in the room together "rotten" off, and XiaoWan's necrosis pathology is that although the furniture is "rotten", but the house frame is good, "This is very similar to the spleen embolism pathology that has appeared before." ”
"There is no blood supply." Yang Jun, deputy chief physician of the Department of Nuclear Medicine, said that Xiaowan's ECT nuclide perfusion scan results showed that there was no blood supply to Xiaowan's lungs where the lesion appeared, and sure enough, as Chief Physician Zhou Hua guessed, because Xiaowan's embolism appeared in a very small pulmonary artery branch, so pulmonary artery CT angiography could not be captured at all, and after the formation of a period of time, it was naturally re-passed, so the corresponding lesions would disappear, but at the same time there would be new vascular embolisms, so new lesions would appear elsewhere. There is also no serious danger to her life at this time.
Why is there a pulmonary embolism?
It is caused by this immune disease
So why does Xiaowan have pulmonary embolism so frequently? If you want to eradicate Xiaowan's lesion, you also need to find the cause.
In general, the common cause of pulmonary embolism is tumors, and hypercoagulable blood caused by malignant tumors can manifest as venous thrombosis of the lower extremities, and the embolism falling down will block the pulmonary arteries and cause pulmonary embolism. Another common cause is that sedentary caused a blood clot in the veins of the lower extremities, and the blood clots run into the lungs. Once the above two kinds lead to pulmonary embolism, it is very dangerous, if the embolus is relatively large, once the blockage is not unblocked in time, there will be a danger to life.
Xiaowan did not have the above conditions, so why did she cause pulmonary embolism so often? Chief physician Zhou Hua, who has clinical experience, has the cause of autoimmune diseases in his brain.
Through a series of immune blood tests, Xiaowan had positive antibody indicators for Sjogren's syndrome, but strangely, she reported that she did not have symptoms of Sjogren's syndrome such as dry throat, dry mouth, and dry eyes.
"The ability of the glands to take up and secrete isotopes is decreased." Through further salivary gland nucleic acid scans and biopsies, it was found that Xiaowan's salivary glands had changed function, further supporting her to have an autoimmune disease such as Sjögren's syndrome. The pathological biopsy of the salivary glands that was completed immediately after that directly saw the salivary glands being invaded by inflammatory cells and the glands atrophy, which effectively helped to confirm the diagnosis of Sjogren's syndrome.
Sun Chuanyin, deputy chief physician of the Department of Rheumatology and Immunology, said that Sjogren's syndrome is a chronic inflammatory autoimmune disease, which mainly violates exocrine glands such as tear glands and salivary glands, typically manifested as dry mouth and dry eyes, and can also affect the lungs, kidneys, digestive system, blood system, nervous system, etc., causing organ involvement throughout the body.
Patients with Sjögren's syndrome will attack some of their own glands, and our human body's immune mechanism, once it feels that the dangerous molecules are close, will immediately send antibodies to attack the antigen, which is very similar to "cannibalism", the final involvement is still their own blood vessels, once the blood vessels are affected, it is easy to cause blood clots, and the thrombus falls into the lungs to form a pulmonary embolism.
"Fortunately, the diagnosis is timely, and if the blood clot is allowed to fall into the lungs, it is very dangerous once a large embolism is formed." Chief physician Zhou Hua said that when the pulmonary embolism is severe, it can lead to sudden death.
"It may be that pregnancy 'activates' Sjogren's syndrome." Sun Chuanyin, deputy chief physician, said that the causes of autoimmune diseases are complex and the onset of the disease is secret, "fortunately, this disease did not appear during pregnancy." ”
Sun Chuanyin, deputy chief physician, stressed that the antibodies produced by autoimmune diseases such as Sjögren syndrome also attack embryos as foreign invaders, resulting in miscarriage or fetal stoppage, "so patients with such immune diseases must check for medical treatment before pregnancy." ”
At present, Xiaowan is receiving anticoagulant drugs and medication for Sjögren's syndrome, and she has finally overcome the guerrilla war with stubborn lesions.
This article is the original of the First Hospital of Zhejiang University