After being separated from my family, I became a darling of the military region thanks to my medical

The old man lifted the blanket, revealing a loose hospital gown.

Ye Zhen placed her right hand flat on the old man's upper right abdomen and gently pressed down.

Take a deep breath.

As she inhaled, her fingers traced down the lower edge of her ribcage.

The edge of the liver can be felt three fingers below the ribs; it is rather hard.

She moved to the left side.

spleen.

Fang Yun wrote "four fingers below the ribs" in her medical record.

Ye Zhen's hand started from her left ribcage and moved down, one finger, two fingers, three fingers, four fingers—she stopped at the fourth finger.

I pressed down gently with my fingers twice, then probed down another half an inch.

"Your spleen has grown a little larger since the last checkup."

She didn't look at Fang Yun when she said this; her gaze was fixed on her fingertips.

Fang Yun opened her mouth, looked at last week's medical record, and her expression changed slightly.

"Last week's physical exam showed four fingers below the ribs..."

"Now four and a half fingers."

Ye Zhen withdrew her hand and helped the old man cover himself with the blanket.

"I have a few questions for you."

"Ask away."

"Have you experienced dry, red, or blurred vision in the past three months?"

The old man thought for a moment.

"It is a bit dry, you know, I'm getting old, wearing reading glasses for a long time makes my skin dry."

"Do you ever experience dryness in your eyes, like sand is rubbing against them, even when you're not wearing your reading glasses?"

The old man paused for a moment.

"...Yes, I have."

As if reminded of something, he slowly said, "For a while, it was really gritty, and I even asked the nurse for extra eye drops a couple more times. Then I had a fever for a few days and forgot about it."

Ye Zhen's gaze remained unchanged.

"What about your joints? Knees, fingers, toes—have they ever been swollen or painful?"

"I didn't notice."

The old man wiggled his fingers. "I'm getting old. I have aches and pains all over, and I can't even tell what's wrong with me."

Ye Zhen nodded.

"One last question."

Her gaze fell on the old man's left forearm, which was sticking out from under the blanket.

"Do you remember the red rash you had on your arm before?"

"I remember. Dr. Fang said it was a drug allergy, and it subsided after stopping the medication for two days."

"What did those red spots look like before they disappeared? Were they flat or raised?"

The old man thought for a moment.

"It's drum-shaped, and it feels a bit hard to the touch."

"Does it itch?"

"It's not very itchy, it's just scary to look at."

Ye Zhen didn't ask any further questions.

She lowered her head, gently lifted the cuff of the old man's left forearm, and brought the skin close to her eyes.

Sunlight streamed in through the window, falling on that withered, yellow forearm.

Ye Zhen's gaze moved inch by inch along the inside of her forearm.

It suddenly stopped.

Her index finger touched a spot—about two inches above her wrist joint—where there was a small patch of very faint pigmentation on the skin, slightly darker than the surrounding skin, almost invisible unless you looked closely.

"here."

She looked up at Fang Yun.

"Have you noticed this mark?"

Fang Yun leaned over and took a look.

"……No."

Her voice was strained.

Ye Zhen gently touched that patch of skin with her fingertip.

"These are not the marks left after a typical drug rash has subsided."

She pressed it again, feeling the texture under her skin.

"After the drug rash subsides, the skin will return to normal and will not leave this pigmentation. The thing that was originally growing here had inflammatory infiltration that invaded the dermis."

Fang Yun's face paled slightly.

Ye Zhen pulled down the old man's sleeves and helped him tuck his arms back into the blanket.

"Thank you for your cooperation." Her tone was gentle. "Get some rest and don't overthink it."

The old man glanced at her.

"Girl, you're different from those doctors."

Ye Zhen smiled slightly.

"You should rest and recover; leave the rest to us."

She stood up, turned around, and walked towards the door.

As they reached the threshold, Fang Yun followed, lowering her voice.

"Dr. Ye, that patch of skin..."

"Let's talk in the meeting room."

---

Back in the conference room on the second floor, Ye Zhen did not sit down.

She first went to the lightbox and clipped the CT scans onto it one by one.

Turn the lightbox brightness to the highest level and start looking at the first group.

Spend at least one and a half minutes on each image. After viewing them, place the images from the three adjacent layers side by side and compare them back and forth.

Then I went to the microscope.

Which box contains lymph node pathology data?

The old professor from the pathology department stood up from the back row and personally handed over the glass case from the second row.

"Dr. Ye, these are the slides I stained. The diagnosis is atypical lymphoproliferative lesions, and further immunohistochemistry is recommended."

Ye Zhen clipped the slice onto the stage and bent down to focus.

The image under the lens gradually became clearer.

She adjusted the fine focus, her gaze sweeping across the field of vision inch by inch.

The meeting room was so quiet that you could hear the sound of someone pushing a flatbed cart in the distance down the corridor.

About three minutes later, Ye Zhen straightened up.

"Director Fang, you saw the lesion on that forearm just now. That's not a drug rash."

She walked to the middle of the long table, picked up a piece of chalk, and drew a line on the small blackboard in the conference room.

"The diagnostic approach to this case went astray from the very beginning."

The pen of the young resident doctor in the back row paused on the notebook.

Ye Zhen wrote three keywords on the blackboard.

fever.

Swollen lymph nodes.

Multiple organs are affected.

"What was your first reaction upon seeing these three?"

Fang Yun answered.

Lymphoma.

"Yes. Then you did a bone marrow aspiration and a biopsy, had doubts, and then ruled them out."

Ye Zhen turned around to face the crowd.

"But several clues have been overlooked."

She added a few lines of smaller writing next to the chalk writing.

First, the periodic heating pattern.

Second, polyclonal globulins are elevated, not monoclonal ones.

Third, recurrent oral ulcers.

Fourth, forearm lesions – not drug eruptions, but inflammatory infiltration in the dermis, leaving pigmentation after resolution.

Fifth, during the physical examination just now, the patient mentioned that his eyes were dry and he had experienced a gritty feeling.

Sixth, those so-called abnormal cells in bone marrow aspiration.

"When you look at these things together, they don't point to lymphoma."

Zhong Youwei tapped his finger unconsciously on the table.

"So what do you think it is?"

Ye Zhen drew a circle on the blackboard, putting all the keywords together.

"Necsiotonic lymphadenitis complicated with systemic vasculitis."

Fang Yun's mouth opened slightly.

"However, it cannot be completely certain yet."

Ye Zhen put down the chalk.

"Three things need to be done to verify this."

"First, take another lymph node biopsy, and this time try to do several key immunohistochemical stainings."

Her gaze swept toward the elderly professor in the pathology department.

"Focus on myeloperoxidase to rule out issues related to tissue cell origin."

The old professor's pen hovered in mid-air, and his lips moved slightly—few people present had heard of this marker.

Ye Zhen didn't stop to explain and continued speaking.

"Secondly, take a small piece of skin for biopsy from the area of ​​residual pigmentation on the forearm. I felt it during the physical examination just now, and there is still a residual hardening in the dermis. If the pathological section shows inflammatory infiltration and fibrinoid necrosis of the blood vessel walls, the diagnosis of vasculitis will be confirmed."

"Third, check complement and anti-neutrophil cytoplasmic antibodies." She paused for a moment, "This test may not be available domestically at present, and we need to find a way to send the serum to a laboratory abroad. But if vasculitis is present, these two tests will definitely show abnormalities."

She spoke slowly, leaving a half-beat pause after each sentence so that the person taking notes could keep up.