Medicine is not just about curing ailments; it's also about unraveling the intricate stories of human health. In this post, we embark on a medical storytelling journey, weaving together symptoms, treatments, and case studies to shed light on the enigmatic world of healthcare.
It started when a man began to feel pains in his back and body. He started to fell unwell, developing lesser appetite for food and drinks. He was able to exercise for a long time but in recent time, was not able to exercise, and would feel extremely weak after the exercise and would take tylenol to make it through the days pain. At night when he slept, he didn't have good sleep and would occasionally wake up sweaty at the middle of the night.
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Over time, black streaks started to show in his finger, and he had lost weight. He felt concern for the drop in weight but he felt it was as a result of not properly eating so he dismissed it. Soon, he noticed that he has a mass on his right palm and thought it was as a result of exercise, so he just continued with his daily activity.
Typical of most people that experience certain signs and symptoms, he dismissed them and just believe his immune system would fight them off. Fast forward few weeks after, he realized that his pains hadn't gone and were already becoming a part of his life but then, he experienced a sharp abdominal pain which wouldn't go, and decided to visit the hospital.
As the weeks pass and his symptoms persist, a sharp and relentless abdominal pain forces him to seek medical attention. The hospital's corridors bear witness to his arrival, his body betraying signs of distress, a high temperature and an accelerated heart rate. The doctor's examination reveals a tender abdomen, guarded and tense in the upper left quadrant.
Listening to his heart gave a high-pitched decrescendo murmur during diastole. The nodule in palm was now painful and warm. CT-Scan showed an infarction in the spleen as a result of lack of oxygen. This means that the splenic artery didn't supply blood to the spleen, and when the spleen doesn't get blood supply by the artery, the muscles where the artery supplies start to die.
To see what has happened to the hand, a CT angiogram was done where iodine rich die is ingested into the arm during the CT scan to enable proper visuals of the blood vessels. The CT scan revealed an Aneurysm of the Ulnar-artery which runs around the pinky side of the arm.
WLet's delve into the term; "an aneurysm", a weakening of an arterial wall that can lead to bulging and even rupture. Further investigations via an Echo cardiogram reveal a vegetation on a heart valve, a telltale sign of "infective endocarditis", an infection of the endocardium. The culprit might be a bacterium like Streptococcus Salivarius, harmless in the mouth but perilous once it infiltrates the bloodstream
If the bacteria gets into the blood and find its way into the heart, it can find its way to the aortic valve. If there is an underlying condition such as a bicuspid aortic valve where the aortic valve has two leaflets rather than three leaflet. The vegetation on the valve can then become as septic emboli which can get stuck in a very narrow blood vessel like that of the hand. This can lead to the weakening of the collagen and elastin of the ulnar artery wall causing it to because an aneurysm.
This emboli can travel to the brain causing a stroke, to the vessels that supply the heart causing a heart attack, and to the eye vessel which can lead to impairment. Treatment using antibiotics in fluid can help treat the bacteria infection but in cases where the infection is large, an invasive surgery can be done.
Reference
- https://www.nejm.org/doi/10.1056/NEJMicm1603196
- https://www.radcliffecardiology.com/articles/mycotic-aneurysm-ulnar-artery
- https://www.sciencedirect.com/science/article/pii/S1533316705000713
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3911234/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280456/
- https://www.ncbi.nlm.nih.gov/books/NBK534214/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793190/