[Patient, Xiao Yunyun, female, 1 year and 2 months old

Symptoms: persistent fever for 12 days, bilateral bulbar conjunctival congestion, bleeding from eyes, mouth, nostrils, navel and other organs, diffuse congestion of oral mucosa. Abdominal pain, facial paralysis and arthritis. Coronary artery damage.

Diagnosis: This disease is an atypical rare disease and cannot be diagnosed because the patient's diagnostic skills are too low.

Tip: Lymphadenitis, infectious mononucleosis, urinary tract infection, pneumonia, EB virus infection, etc. can be clearly ruled out. Specific symptoms and treatment plans need to be upgraded to diagnostic technology (two stars, 9)]

Tanglou left the ward very helplessly. Once again, the diagnostic skills were not high enough. It can only be said that there are still many rare cases in the usual diagnosis.

Especially for this rare disease with atypical symptoms, the human body is really too complicated. Moreover, many times a disease is often complicated by various complications. Even very experienced doctors will misdiagnose it through various misunderstandings.

, delaying treatment, and even leading to patients not receiving timely treatment and dying of the disease.

"Oh, I hope the expert consultation will be able to find out the condition."

Tanglou can only place its hope in Deputy Director Shen Bingbing and senior doctors from other departments.

Soon, the general consultation organized by Shen Bingbing started on time. Dr. Wang Chuan was naturally invited, as well as the general surgery departments of Qingping, Hangcuishan, and Tanglou.

In addition, we also invited senior attending physicians from the dermatology department, senior attending physicians from the cardiothoracic surgery department, and senior attending physicians from the urology department.

Overall, the consultation lineup this time was very strong.

Since the patient's condition was very critical, no one spent much time on the subject. Deputy Director Shen Bingbing directly turned on the projection and began to review the patient's treatment over the past few days, as well as various examination data and review of failed treatments.

Tanglou was also given a thick pile of photocopied documents by Guo Cai'er, which contained various data and auxiliary inspection information.

Deputy Director Shen Bingbing was the first to put forward her speculation: "The child had unexplained fever that lasted for 12 days. The auxiliary examination showed that the white blood cell count ranged from 8.31×109 to 36.9×109L. The hematocrit decreased, C-responsive protein increased, and the liver

Functional impairment, and polymorphic rashes appear. The symptoms are very atypical, complex, and scattered. I personally think that there is a problem with the immune system, causing the mucous membrane to be attacked by the virus."

"The preliminary guess is that it is some kind of infection. The urine culture done yesterday detected Escherichia coli infection."

Shen Bingbing pushed her eyes up to her nose: "Is it possible that Escherichia coli infection causes an overreaction of the patient's immune system, leading to a systemic disease?"

After hearing Shen Bingbing's guess, several attending doctors were silent for a while. They could only say that it was possible, but it was not enough to explain all the patient's symptoms.

The attending physician of the cardiothoracic surgery department immediately began to put forward his thoughts: "I do not agree with Director Shen's speculation. It is absolutely impossible for a simple Escherichia coli infection to have such a large body reaction. It can only be said that the patient has

A complication of coliform infection, but definitely not the main cause."

"I agree with Dr. Lin."

Another attending physician also agreed.

Dr. Lin continued: "I carefully looked at the patient's coronary arteries, and the picture showed that the patient's coronary arteries were larger than 2.5mm, which is far beyond the normal value for infants aged 0-3 years. Therefore, the patient is likely to have myocardial infarction.

Infarction, sudden death or ischemic cardiomyopathy. Although I can't determine the patient's condition yet, I recommend immediate anti-infective treatment for fever and constant monitoring of the heart condition."

Hearing what Dr. Lin said, it was obvious that all the doctors present were very concerned, but they all agreed that in many cases, when the condition cannot be diagnosed, the best option is conservative treatment, nutritional support, starting with anti-infection.

Start by hanging on to your life first.

Listening to the opinions of various attending doctors, Tanglou also frowned. Besides waiting, another way is to upgrade the two-star diagnostic technique as soon as possible. However, the diagnostic technique is very rare, and he probably won't be able to get it even if he spends all his gold coins.

"well."

Tanglou sighed, and Qingping beside him patted Tanglou's thigh under the table and said softly: "This situation is very normal. It cannot be diagnosed, so we can only send it to a higher-level hospital. Don't be too conceited."

Responsibility. After all, we are doctors, not gods."

"Um."

Tanglou smiled bitterly.

At this time, Dr. Fang, the attending physician of the dermatology department, put forward another idea: "The patient's body temperature has been between 38-40°C for 12 consecutive days, the conjunctiva is congested and overflowing, and the trunk is polymorphic rash. Combined with the current season, there are

Isn’t it possible that it’s Epstein-Barr virus infection?”

After hearing Dr. Fang's diagnosis, several attending doctors also exchanged opinions. So far, this is the most likely diagnosis.

"I agree."

"I agree too."

Two attending doctors in a row expressed their agreement, and it seems that the consultation will be deepened in this general direction.

Suddenly a very discordant voice sounded: "I think there are other possibilities, it is not EB virus infection."

The person who spoke was, of course, Tang Lou. Although he did not know the final cause of the disease, the system diagnosis clearly ruled out EB virus infection. He could not let everyone go down the wrong path. If he really received corresponding treatment, it would take two

Only after treatment is ineffective can a new direction be decided, which is very detrimental to the patient's diagnosis.

Everyone looked at Tang Lou. The faces of the general surgery department were a little better, and they were still very concerned about Tang Lou's opinion. The chiefs of cardiothoracic surgery and dermatology suddenly frowned.

However, after all, this is the territory of general surgery, so they did not show too much anger, but their tone was still a bit cold: "Oh, I wonder what this little doctor has to say?"

Shen Bingbing also looked at Tanglou, her face full of curiosity. This kid is really brave. He often dares to speak out in such senior consultations.

But, I don’t know what useful information he can tell.

"I don't know what the cause is, but I think it's not a simple EB virus infection. The reason is the same as Dr. Lin's previous question about Director Shen."

Tanglou's face was solemn, he stood up very seriously, leaned forward, took the laser pointer from the table, then pointed it at the projection, and at the same time motioned to Shen Bingbing to slide the page.

The other chiefs were all stunned by Tanglou's command of Director Shen so naturally. This boy was so courageous.

Even Qingping is a little convinced and proud.

It is indeed a tenement building.

"I personally feel that the cause of this treatment is more rare and complicated than all the possibilities we currently think of. I cannot point out the final answer, but I hope my suggestions can help everyone avoid detours."

Hearing Tanglou's old-fashioned words, several of the chief doctors were certainly disdainful and even wanted to laugh. Young people had better be modest.

"In addition to EB virus infection, if I only catch a scale feather, I can even infer that lymphadenitis is complicated by infectious mononucleosis based on the patient's cervical lymph node enlargement and unilateral neck excessive swelling with a diameter greater than 1.5cm.

disease."

Upon hearing Tang Lou's statement, several attending doctors were stunned, especially Dr. Lin, who had not paid much attention to Tang Lou's opinion before.

I immediately looked through the data, and it turned out that if you look at this disease this way, it is very similar to lymphadenitis combined with mononucleosis.

"Look here, this data, and this set of pictures, can I still diagnose Mycoplasma pneumoniae infection?"

Tanglou analyzed the easily misdiagnosed diseases provided by the systematic diagnosis technique.

"If you combine these data, it may be a urinary system infection... So I personally think that the patient's situation is more complicated and rare than we imagined. Due to my personal experience, I cannot draw a conclusion and put forward these

The symptoms are just to give you some ideas. Is there an atypical disease that can combine so many diseases?"
Chapter completed!