The Enhanced Doctor-Chapter 593: The condition of indeed worsened

"Teacher Liu, something seems off. The patient’s blood biochemistry doesn’t show anything out of the ordinary. The triglycerides are at 1.67, total cholesterol is at 5.17. The blood sugar level is 7.3, which is also normal considering it was taken after a meal."

Xu Yino came over with the lab report.

"Let me see. So, is the only anomaly the elevated white blood cell count?" Liu Banxia asked with a furrowed brow.

Xu Yino nodded in confirmation.

"I should discuss this with Brother Hui. The patient’s condition might be quite dangerous. Has his family already arrived?" Liu Banxia asked after looking at the report.

"Yes, they have arrived. Teacher Liu, do we need to move the patient to the ICU?" Xu Yino asked worriedly.

"Not for now, but we have to keep a close eye on the patient’s vital signs. Also, could you call Peng Bo and Xu Guosheng over? If Chen Xuehai is available, ask him to come too," Liu Banxia instructed.

Xu Yino was startled; this was no simple consultation anymore.

"Are the blood biochemistry results out?" Xu Hui asked.

"Take a look. I’ve called people from cardiology, neurology, and cardiothoracic surgery to discuss this. I have a terrible feeling about this patient," Liu Banxia expressed.

Hearing Liu Banxia’s words, Xu Hui also furrowed his brows.

Is this what they call a doctor’s intuition? Liu Banxia had seen a considerable number of patients, many of whom he was asked to see for consultations. If he was saying this, there might indeed be a problem.

After examining the test report closely, he shared Liu Banxia’s concerns.

There’s a reason for everything. It’s normal for the patient’s white blood cell count to be slightly elevated because he has a cold. Having a fever would naturally cause it to rise.

Moreover, this elevation is within the normal range for inflammation and hasn’t reached an alarming level.

So, what’s causing all these blood clots in the patient now? If this issue can’t be figured out, even if thrombolytic drugs get him through this episode, what about the next one?

"It’s been a long time since President Liu has made such a big fuss. What’s going on?" Chen Xuehai, who had hurried over, asked.

"It’s very complicated and quite a headache. Now that everyone’s here, let’s discuss it. Xu Yino, report," Liu Banxia instructed.

"Ah, okay," Xu Yino replied, hesitating slightly.

"The patient is a 53-year-old male with a history of diabetes who came to the hospital complaining of a cold. He had a fever, cough, and headache. Upon examination, moist rales were heard in his left lung, but his heart sounds were normal."

"We did a complete blood count and X-ray. The blood count showed a slightly elevated white blood cell count. The X-ray showed mild inflammation in both lungs, with milder inflammation on the right side. He was given an intravenous infusion of levofloxacin in sodium chloride solution, but suddenly developed shortness of breath."

"After examination, it was found that he had multiple embolisms in the lungs and brain. We performed further blood biochemistry tests, which were normal. Currently, the patient is in the ward receiving symptomatic intravenous therapy."

"The films are up on the light box," Liu Banxia continued. "He also has some sinusitis, likely triggered by his cold."

"I also called over the interns because I’m uncertain whether the patient’s emboli were caused by long-term accumulation followed by sudden detachment, or a rapid response to some underlying condition."

"The key issue is the simultaneous occurrence of multiple pulmonary and cerebral embolisms. I’m worried about the future—what if his condition recurs?"

"This case really is complicated. What are your thoughts?" Chen Xuehai asked.

"It’s hard to determine at this point. We need to brainstorm together," Liu Banxia responded.

"Then, let me start things off," Xu Hui chimed in.

"You all better note this down because opportunities like this are rare," Liu Banxia reminded the interns.

Xu Yino and the others took out their notebooks. Qing Kewa, however, found it easier; she just took out her phone and started recording.

They could understand what they were hearing, but write in Chinese? You must be joking.

"The formation of blood clots can be attributed to three factors," Xu Hui continued. "The first is vascular wall disease, the second is changes in blood components, and the third is changes in hemodynamics."

"We’ll start with the last two. Changes in blood components, such as polycythemia vera or thrombocytosis, mean an increase in red blood cells or platelets, making the blood thicker and putting it in a hypercoagulable state. This can occur in some patients after childbirth or in those with tumors."

"However, based on our blood test results, I think we can rule that out. Both the patient’s routine blood tests and biochemistry are normal in this respect."

"Changes in hemodynamics often cause abnormal blood pressure. The patient’s blood pressure was normal when he was examined, so this can also be ruled out."

"Excluding these two, I suspect the first type: vascular wall disease. There are many causes, such as congenital factors, age, family medical history, etc. Acquired factors include hypertension, hyperlipidemia, diabetes, smoking, alcohol consumption, and so on."

"Do you think that our patient’s vascular wall disease was caused by diabetes? Or could it be related to cerebral arteritis, congenital vascular malformation, amyloidosis of blood vessels, or other vascular diseases?"

"Otherwise, I can’t figure out why it would progress so quickly, and it’s happening in both the lungs and the brain simultaneously. Although the cause is unknown right now, I’m leaning towards these emboli originating from a single underlying cause."

"This is also Liu Banxia’s primary concern. If we can’t find the cause, even if we successfully dissolve the thrombus this time, the patient faces a risk of readmission."

Liu Banxia nodded. "Exactly because of such concerns, everyone was called in. The patient also has diabetes, so we must be cautious with any further tests."

"Moreover, we can’t subject the patient to a full battery of tests; I’m afraid the family would object before we even got to the third one. Not to mention, the patient is currently undergoing thrombolytic treatment, so we must be extremely careful."

"I’m inclined to think it’s vasculitis," Peng Bo said.

"And considering the patient’s condition, it could well be a systemic disease. There could be numerous causes, such as drug reactions, infections, herpes simplex virus, and so on. I think we can move forward with relevant tests."

"What about Doctor Xu and Dr. Chen?" Liu Banxia looked at Xu Guosheng.

"We can follow this line of inquiry. These types of diseases require a gradual process of elimination. We need to explain this clearly to the patient’s family and continuously monitor his condition," Chen Xuehai said.

Xu Guosheng also nodded. "That’s right. Diagnosing such cases isn’t a one-step process; it requires ruling out possibilities."

"The physical examination also needs to be meticulous. Many cases of vasculitis are associated with underlying conditions, and these autoimmune diseases often have cutaneous manifestations."

"For example, skin lesions or nodules along the course of blood vessels. However, some manifestations are not very obvious. A routine urinalysis for the patient is also necessary, and we need to monitor his liver and kidney function."

"Even though the patient is in a general ward now, he should be managed as if he were an ICU patient. The onset of this patient’s illness was quite acute. Regardless of the cause, even if we use thrombolytic drugs, a recurrence is possible."

"Okay, we’re in agreement then. Let’s proceed with tests relevant to vasculitis. At the same time, it’s crucial to communicate with the patient’s family to see if he has experienced any other health issues recently," Liu Banxia said.

"The patient has suffered a stroke and a pulmonary embolism, after all, so direct communication with him might be challenging. Let’s try to get more information from his family."

The interns nodded and then headed up to the ward.

"This case is indeed tricky. Right now, it feels like we’re a bunch of blind men feeling an elephant," Liu Banxia sighed.

"Regarding this patient, I’m truly uneasy. When I first saw him upon admission, I never imagined a pulmonary embolism and cerebral infarction would develop so rapidly."

Everyone nodded. Considering the current test results and the patient’s presentation, it was indeed highly unusual.

The consultation ended, and everyone returned to their respective offices. Liu Banxia wasn’t idle either; his mind was still working on the patient’s case.

All apparent factors had been considered; the only thing not given significant attention was the sinusitis.

But sinusitis is common with colds. Is it necessary to perform a nasal endoscopy just for that?

Thinking of this, he took out his phone and dialed Xu Yino.

"Teacher Liu, this is Xu Yino."

Xu Yino’s voice came through after the call connected.

"Let’s also do a blood culture, sputum culture, and nasal swab culture for the patient. See if there’s any bacterial infection causing this," Liu Banxia suggested.

"Alright. The patient does have copious nasal discharge and some nasal congestion," Xu Yino replied.

"We need to closely monitor this patient’s condition. I’ll make arrangements shortly and then go to the ward to check on him," Liu Banxia told him.

"Okay, we’ll perform another physical examination on the patient to check for any new developments," Xu Yino responded.

Liu Banxia put the phone in his pocket and gulped down a glass of water.

He also leaned towards vasculitis. But even if it were vasculitis, it would surely be triggered by an underlying condition. If the root cause isn’t found, it’s merely treating the symptoms, not the disease itself.

Could it simply be due to diabetes? But the patient’s blood sugar is very well controlled.

Diabetes can indeed cause many conditions to manifest atypically. However, this usually happens in patients who don’t adhere to their medication regimen, or those whose blood sugar isn’t controlled by oral medication and who also don’t take insulin.

The patient’s current blood sugar levels are very good, he doesn’t smoke or drink, and his cholesterol and lipid levels are also within the normal range. So, what could be the problem?

This was giving him a headache. For now, he was just speculating. If only they could perform a contrast-enhanced CT scan, they could get a clearer picture of the vascular situation and see if there were stenoses or other issues elsewhere.

Just as he was pondering this, Xu Yino rushed in. "Teacher Liu, the patient’s cough has worsened, and his temperature has risen to 38.8 degrees Celsius!"

Liu Banxia sighed inwardly. The patient’s condition had indeed deteriorated.