Allogeneic bone marrow transplantation is one of the important means of treating certain types of leukemias. This treatment process mainly uses bone marrow mobilizers to promote the donor's hematopoietic stem cells into the blood. Then, by separating the blood collection and centrifuge with less than ordinary blood donation, about 10 ml of hematopoietic stem cell solution is extracted, and then injected into the body of the recipient through intravenous veins. This hematopoietic stem cell solution is actually a blood product. Blood products are of course possible to spread various diseases.

"According to general principles..." Dr. Pascal frowned and thought for a long time. "Bone marrow transplant should not be contagious."

Generally, allogeneic bone marrow transplants usually occur among the relatives of the recipient. Most of them are immediate relatives. Some patients with poor luck may not be able to match with their relatives. At this time, the disease needs to be treated through hematopoietic stem cell donation. The bone marrow mobilization agent requires at least four days of continuous injection. The donor must undergo a considerable number of disease examinations from the beginning of determining the donation to ensure that the hematopoietic stem cells he donated will not cause the disease to spread. Moreover, even if there are really any newly infected diseases, the donor will show some clues during the four-day mobilization agent injection.

"What about that?" Sun Lien also knew that the inspection before donation was very important and very strict. But this does not mean that there would be no non-artificial omissions - after all, accidents are unexpected.

"There may be some pathogen transmission from unconventional examination items?" Dr. Pascal was not very sure about this. He just made a speculation based on his research experience and research direction. "There may be some viruses that have no specific antibodies and no specific symptoms, right?"

Sun Lien rolled his eyes. There were no specific antibodies or specific symptoms. If this infectious disease really exists and can manifest itself as Yang Jianqiang, then all doctors and scientists in the medical field can wash their necks and wait for death. How excited are doctors when they encounter rare cases? Just look at the medical records and reports in journals published every month.

However, there is indeed no problem with Dr. Pascal's inference. Without specific antibodies, it is possible to bypass the pre-donation examination. Without specific manifestations, it is possible to make the donor and the doctor ignore the manifestations at the same time. If Lin Jianqiang's current cause comes from the donated bone marrow, then only pathogens that meet both conditions can be done.

"MRI results are coming out." Two people were staring at the door, and Liu Pingchuan walked out of the room with the newly released MRI image. His brows were very deep, and there were layers of ravines in the middle of his eyebrows. "Xiao Sun, come and take a look at this."

The eight edema areas showed obvious performance on MRI, and the most noticeable one was the edema area close to the basal layer. Although it looked a little blurry, it was indeed an almost round gray spot.

"MRS shows that Cho metabolic levels increase, while NAA metabolic levels decrease." Liu Pingchuan estimated that Sun Lien could only watch the fun, but could not see the specific trick. So he explained, "Cho represents the degradation product of myelin, which is related to maintaining the integrity of myelination. The decline in NAA metabolic levels suggests damage to brain cells."

"Since the morning has changed so much..." Sun Lien frowned and asked, "Can it be herpes simplex encephalitis?"

Herpes simplex encephalitis is a common type of viral infection. The biggest feature is that it progresses quickly. But this conjecture was denied by Dr. Pascal, "Herpes simplex encephalitis first occurred in the temporal lobe, and this patient suffered from multiple occurrences. There was no sign of cerebral edema."

"Where is Cryptococcal infection?" Dr. Pascal asked after pondering for a moment, "This infection occurs hidden..."

"There are no soap bubble-like cysts." Liu Pingchuan also joined the discussion. "And Cryptococcus will not be invisible - the morning examination will not change so quickly."

"So, there are three things we need to understand now." Sun Lien made a statement and summarized it, "First, why the condition progresses so quickly. Second, what are the causes of his symptoms? Third, whether brain cells damage and multiple edema are direct manifestations of the disease he suffers from."

Pascal nodded thoughtfully. The first two questions raised by Sun Lien are simple and direct, while the third question has some profound meanings. If you only think about infectious diseases, some autoimmune diseases with insufficient characteristics may be misdiagnosed as infectious diseases. Considering that the patient's condition changes after adjusting the immunosuppressive regimen, this possibility also needs to be included in the consideration.

"Put mannitol first to reduce brain pressure." Sun Lien shook his head. He originally thought that this imaging examination could provide some direct clues to assist in the diagnosis, but unexpectedly, after going around for a while, the diagnostic ideas returned to the starting point.

Now the plan is... I can only stabilize the patient's condition first. Sun Lien suddenly felt a little irritated when he looked at Yang Jianqiang who was pushed back to the emergency room.

Being a doctor is actually just a little bit of a promising. The salary is not high and you are exhausted. Being misunderstood and wronged by patients is commonplace. What makes doctors feel that their work is meaningful... is actually to diagnose difficult and complicated diseases in patients and cure fatal diseases.

Save a life and then gain a sense of self-satisfaction. This is the main motivation that supports most doctors working hard every day.

And now... the acquisition of this motivation seems to have become more difficult. Sun Lien is not only a little irritable, but even feels a little angry.

"What should I do next?" After calming for a while, Sun Lien asked Dr. Pascal, "Do you have any suggestions?"

"I think..." Dr. Pascal thought for a while and put forward his own idea, "Do you have a PCR test for blood and cerebrospinal fluid."

"What project is checked?" Sun Lien asked with a frown. PCR testing is generally a detection method used to verify pathogen conjectures. PCR testing without even a reliable conjecture is simply a provocative method of preparing to find fault and fight with the laboratory department.

"Let's check for common infections after bone marrow transplantation first." Dr. Pascal spread his hands, "Parasites that can cause central nervous system symptoms include fecal nematode disease and toxoplasmosis gondiosis. For viruses, we have just ruled out VZV (shings zoster virus). The course of EBV (Epstein-Barr virus) is not so fast. The possibility of JCpolyomavirus (JC polyomavirus) seems to be the greatest at present."

"Progressive multi-leukocerebral cerebral disease?" Liu Pingchuan understood Dr. Pascal's guess direction. "This disease is very rare."

"But it can be correct for Cho metabolites, and it is also a subacute onset." Dr. Pascal seemed to be confident in this speculation. But then his slightly excited expression cooled down again, "But... the prognosis of this disease is not very good."

It's not just not very good, it's simply not good. There is no effective treatment for progressive multi-leukoencephalopathy caused by JC polyomavirus so far. Ordinary antiviral treatment has very poor effect on JC polyomavirus. The only way to improve symptoms is to enhance immunity.

For Yang Jianqiang, if he is really infected with the JC polyomavirus, it will basically be sentenced to death. Strengthening immunity will trigger an inflammation storm, and then he will die. If he does not enhance immunity, the JC polyomavirus will continue to develop, and more and more white matter will be damaged, and he will still die.

"This..." Sun Lien held his breath in his chest. He really didn't expect this would be the result. After holding it in for a long time, he sighed and suggested, "Let's check it out. I hope it's not JC."

Liu Pingchuan was going to the rescue room to get angry with Zhou Jun, and the matter of explaining the patient's condition to Zhou Jun was naturally taken down by Vice President Liu. Dr. Pascal returned to the outpatient clinic with a melancholy expression. Sun Lien stood alone at the door of the imaging department, holding his hands in his chest and pondered.

Dr. Pascal's diagnosis was very clear, and he narrowed the initial suspicion to two parasites and one virus. The experienced veteran doctor is indeed much stronger than a naughty young man like Sun Lien. But a naughty feeling that something was wrong in the narrative just now.

According to Dr. Pascal's explanation, JC polyomavirus mainly affects the brain, but the onset is mostly chronic or acute. If Yang Jianqiang's onset time starts from blurred vision, there is no problem to calculate it as a subacute disease. However, imaging examinations have proved that Yang Jianqiang's condition has only begun to accelerate suddenly today. If we speculate based on this logic, the diagnosis of JC polyomavirus seems to be a bit untenable.

Moreover, the imaging characteristics do not seem to be very consistent. Sun Lien thought of the imaging results he had just seen. The eight edema areas are distributed in a relatively scattered position. But most of them are at the junction of the cerebral gray matter and the cerebral white matter. Since the disease caused by JC polyomavirus is called "progressive multi-lesion cerebral leukomorphosis", then the main part involved should be the cerebral white matter, not the junction.

But if it weren't for JC... Sun Lien's eyes widened.

"Before I met... Lao Yang must have had a dog." "He said his grandmother had a white cat before. The big white cat with blue eyes was very beautiful. But that was almost thirty years ago."

The patient has a history of close contact with cats and dogs! A buzzing sound in Sun Lien's mind. He suddenly felt grateful for his trip to the capital. If he had not seen the case writing level of Tonghui, he would definitely not have discovered the connection so easily. Only by recording all the information in detail can one find the basis and answers for diagnosis from it!

Sun Lien's diagnosis was that Yang Jianqiang suffered from toxoplasmosis. However, his toxoplasmosis did not come from bone marrow donation, but the eggs lurking in his body for a long time. He was a hidden infection of toxoplasmosis! 8)
Chapter completed!