This doctor has a system

Chapter 114 113. Patient with repeated chest tightness and wheezing

At around 10 o'clock in the morning, a hospitalized patient was admitted from the outpatient clinic.

The male patient, 34 years old, named Bian Pengju, came to the hospital for treatment due to chest tightness and wheezing as the main symptoms. He is a civil servant.

Bian Pengju's original life was pretty good. He got married 5 years ago and his family was in a good position. After marriage, his wife gave birth to him a lovely daughter. The family was originally harmonious and beautiful.

But just 2 years ago, he developed symptoms of fever, cough, and expectoration after catching a cold. After taking medicine at home for a few days, the symptoms did not alleviate, but he still had wheezing.So he hurried to the county hospital for treatment, and the local doctor suggested that he should have a chest CT, which showed pneumonia.

So I infused a few days of antibiotics in the hospital, atomized a little anti-asthma medicine, and the symptoms of fever and sputum were relieved, but I still had mild wheezing, and it had been a long time and I still coughed from time to time.

Within one month after he was discharged from the hospital, he experienced obvious chest tightness and wheezing three times. His family members were very worried and took him to the Central Hospital for another visit.

The doctor over there gave him a lung function + bronchial provocation test, and the result was positive.

"You have bronchial asthma." The doctor told him, "It is estimated that you will need long-term medication." He prescribed budesonide powder for him.

Budesonide is an inhaled glucocorticoid that is most commonly used in the treatment of allergic airway inflammation, such as bronchial asthma and allergic cough.

Bian Pengju took budesonide for a period of time according to the method taught by the doctor after returning home. He felt much better, and he was relieved at the time.

However, after half a year, the symptoms of chest tightness and wheezing started again, and the coughing became more severe, which seriously affected his work and life.

As a last resort, his wife accompanied him to the Central Hospital for hospitalization for a period of time, and his symptoms eased again, so he was discharged home.

then not long after
Bian Pengju was exhausted from the torture, and his wife was not in the mood to go to work. He came to the Provincial People's Hospital this time to find out the cause.

After listening to his narration, Gao Feng quickly comforted him for a while, "We'll check it out for you to see if there's anything you haven't noticed."

He carefully looked at the chest CT that Bian Pengju had taken before, "This shows infiltrates in the lungs." Gao Feng pointed it out to Dong Qianqian.

"Inflammation." Dong Qianqian looked at it.

"Maybe." Gao Feng went through other tests and treatments. Bian Pengju had three pulmonary function tests, and each challenge test was positive. He also had allergic rhinitis, so he was diagnosed with bronchial asthma. Still relatively clear.

Why does the patient have repeated symptoms of chest tightness and wheezing even though he has been using the medicine to control his asthma? Gao Feng fell into deep thought.

"Peeling off the cocoon: Bian Pengju is suffering from a serious illness, and he is anxious and needs your help urgently. Please help him make a clear diagnosis within 5 days." The system released the task in time.

Gao Feng really didn't have a clue, "Sister Qianqian, what do you think about this patient?"

"It may be intractable asthma." Dong Qianqian was not sure, "Why don't you take some medicine and observe it first. According to the patient, he is still relatively sensitive to hormones."

"You can take some medicine first, it's obvious that he's wheezing." Gao Feng agreed with Dong Qianqian's opinion, "Let him take a chest CT, it will be clearer on the computer."

Bian Pengju's latest CT scan was two months ago, and due to improper preservation, some images were lost.

CT films should generally be stored in a cool and dry place, and should not be exposed to the sun or in a humid environment, both of which will cause image damage.

At around 3:[-] p.m., Bian Pengju took a CT scan, and after the office said something, Gao Feng opened the image on the computer.

"This film of his..." Gao Feng looked at it carefully, "There are a lot of nodular lesions, and some of the lesions can be seen with small cavities."

"Fungi?"

The CT imaging manifestations of pulmonary fungal infection have the following characteristics: multiple, pleomorphic, and variable.Multiple nodules refer to multiple nodules, which may be accompanied by surrounding dizziness, and multiple cavities may have solid nodules inside.

"Check the G test and GM test for the patient, keep the sputum and send it for culture and fungal culture." Gao Feng explained to Zhang Tianci.

"Forget it, let him do the bronchoscopy directly, and send an NGS for the lavage fluid." Gao Feng made a decision.

NGS is also called macrogene detection. It does not need to isolate and cultivate pathogens, and does not rely on known nucleic acid sequences to design primers. It can directly sequence and identify samples, which greatly improves the diagnostic efficiency, especially in the detection of unknown pathogenic microorganisms. There are unparalleled advantages.

This inspection also has many disadvantages, the most important of which is that it is expensive.

Gao Feng communicated with Bian Pengju, and the other party was willing to spend the money, even a little urgently, "It's not short of money! I'm ready to spend money when I come to you," he said.

"Let me check what should be checked, and what should not be checked. We are not short of money."

Gao Feng performed a bronchoscopy on him the next day. The microscope showed that the airway mucosa was obviously congested and edematous. When he was lavaged with normal saline, a moderate amount of white sputum gushed out of the airway.

The manufacturer quickly came to collect the specimens, and the NGS tests were all sent to an outside laboratory for testing, which could not be reimbursed.

In the next two days, Gao Feng inhaled budesonide and terbutaline by atomization for Bian Pengju, both of which are commonly used asthma medicines, and his chest tightness and wheezing symptoms were relieved quite well.

On the third day, the NGS test results came out, and the reported Aspergillus fumigatus was a type of fungus.

"It's allergic bronchopulmonary aspergillosis!" Gao Feng suddenly realized.

"You have completed the task of peeling the cocoon, and you have obtained 1 skill point." The system's voice sounded.

Allergic bronchopulmonary aspergillosis (ABPA) is the most common and most characteristic of allergic bronchial mycoses, first reported in England in 1952.The most common pathogenic fungus is Aspergillus fumigatus.

Wheezing is present in nearly all cases of allergic bronchopulmonary aspergillosis.

Gao Feng explained the test results to Bian Pengju, "The inhaled glucocorticoid treatment you used before is not wrong, but you are different from other asthma patients, you also need to use anti-Aspergillus drugs at the same time, otherwise this Symptoms of wheezing may come and go."

Gao Feng prescribed voriconazole tablets for him, "After taking it at home for a month, I will have a re-examination. I will check the liver and kidney function in the first week of taking the medicine. If there is any situation, I will contact you at any time."

Bian Pengju was both happy and worried, "Doctor Gao, why don't I stay in the hospital for observation, I'm always afraid that it will happen again after I go back."

"I'm afraid it won't work, the hospital charges are still quite expensive." Gao Feng said.

"Not short of money." Bian Pengju said.

"It's not about the money either. The beds in the hospital are still very tight." Gao Feng patiently communicated with him, "Don't worry, if you really need anything, just call me."

Bian Pengju discussed it with his wife and decided to rent a house near the hospital, so as to save the trouble of going back and forth when the time comes.

"Actually, you don't need it." Gao Feng persuaded him a few words, but seeing his resolute attitude, he stopped talking, for fear that he would say another sentence: We are not short of money.

This sentence sounds quite bewildering.

(End of this chapter)