Chapter 990: Is 990 PCP Pneumonia?
"Teacher Liu, the test results are out. The blood routine seems fine, but the leukocyte index in the urinalysis is somewhat high." Huang Bo rushed over with the freshly printed test report and scans.
"The tuberculosis antibody is negative, but the values for the five immunity tests are all below normal standards. It matches the previous judgment that there is a slight problem with the immune system, causing a lung infection."
"And then?" Liu Banxia asked.
"I just communicated with the patient carefully again, and the patient self-reported that he might have had weak legs before." Huang Bo said.
"Moreover, the patient has a history of repeated diarrhea in the past one or two months, combined with the current physical signs such as weight loss. I suspect it might be PCP pneumonia."
"If we consider from this direction, we need to conduct HIV screening and malignant tumor screening for the patient. However, I don’t have an accurate check for malignant tumors and need your help."
Liu Banxia frowned, took the lab report, and carefully looked at the patient’s scans again.
One must say that Huang Bo’s consideration is not impossible.
PCP pneumonia is an abbreviation, known as Pneumocystis pneumonia. Many people’s bodies carry the microorganism Pneumocystis jirovecii, but it does not affect normal human bodies.
Because the human body carries so many bacteria—beneficial and harmful—all kinds are intertwined. However, the human immune system is very powerful and can resist many bacterial invasions.
But there’s one thing, if your immune system has problems, it will give these pathogens an opportunity to cause havoc.
Both HIV carriers and malignant tumor patients will attack the immune system. PCP pneumonia is also a common complication in HIV carriers.
Another piece of evidence for Huang Bo’s judgment is the patient’s weight change and history of diarrhea, which could also be the impact of the HIV virus on the digestive system.
If it also affects the nervous system, it may cause intermittent neurological dysfunction. The patient’s symptom of leg numbness also matches this.
"Did you do a detailed physical examination for the patient? Were there any findings of fungal infection, or any herpes, and how is the temperature?" After thinking for a while, Liu Banxia asked.
"Temperature is 38.1 degrees, oral ulcers, but nothing found on physical examination." Huang Bo said.
Liu Banxia nodded, "Do an HIV screening, first see how the screening results are, then consider other instrument checks. This patient needs special attention, keep a close eye on it."
"Okay, I’ll arrange it right away." Huang Bo said and hurried back.
Given the current situation, if it really is PCP pneumonia for this patient, whether it’s caused by the HIV virus or a malignant tumor, it’s not good news.
Actually, there is another group prone to this pneumonia, those who have undergone liver or lung transplant surgery.
Because these patients need to take immunosuppressants to avoid rejection of transplanted organs, thus giving pathogens an opportunity.
However, this patient has no such medical history, so there’s no need to consider it.
Ding! Task release: Strange pneumonia patient
Open task: After the patient was emergency rescued and admitted, lung inflammation and neurological dysfunction were found, suspected as PCP pneumonia, requires further confirmation. Task reward will be given based on the diagnostic result.
It’s been a long time since there was such a task, mainly because Liu Banxia has been busy recently, with the number of outpatient cases being limited, but a lot of unrelated chores.
For this patient’s case, a more detailed examination is indeed needed to confirm the diagnosis.
If not caused by the HIV virus, it could very likely be a malignant tumor somewhere. There’s no indication at the head or chest for now, but checking other organs isn’t easy.
It also involves the issue of excessive medical treatment, you have to make a judgment, otherwise, you need to do a full-body check on the patient and eliminate bit by bit to finally diagnose.
He also needs to help Huang Bo think about it; these matters need to be considered in advance.
Thinking and thinking, he ran out of ideas, and seeing no patients in the internal medicine department, he wandered over.
"Brother Hui, there’s a special case with an emergency patient today; please give some reference." After Liu Banxia finished speaking, he described the patient’s situation.
"Indeed, Huang Bo’s judgment is quite reliable. If not for the weight loss, oral ulcers, and such a long history of diarrhea, we could have considered other directions first." Xu Hui said.
"HIV is, after all, a type B infectious disease; with such a suspicion during admission, we need to do a corresponding rapid screening; otherwise, the responsibility would be significant."
"I haven’t dealt with this illness before. If we want to confirm a diagnosis, do we need to work on the pathogen and conduct the relevant tests?" Liu Banxia asked.
Xu Hui nodded, "Once the HIV screening results are out, we can conduct a bronchoalveolar lavage and get it checked. If it turns out to be HIV carrier, this test needs extra protection."
"If confirmed, the treatment would have to be targeted therapies and hormone treatments. We also need to find out the underlying cause of his immune deficiency; unless we resolve the root cause, this illness is very troublesome."
Liu Banxia nodded, "Let’s wait for the HIV results first. I initially wanted to see Huang Bo’s approach in handling patients, but didn’t expect to encounter such a challenging case."
"And it’s not just him, even I’m scratching my head. Recently, proactive patients visiting internal medicine seem to be less than before, right?"
Xu Hui laughed, "It’s indeed a slow season, but the cold weather is approaching. Once a cold wave hits, just wait, you’ll see respiratory infection patients lining up."
"We’re still okay here; working overtime can keep things going. What about pediatrics? Will you go over there to help? You can’t rely on the current interns and resident doctors."
"Sigh..." Liu Banxia sighed.
"Brother Hui, I do feel a bit worried. Pediatricians are truly scarce resources. Even ICU can replenish staff, but not pediatrics."
"Training new ones wouldn’t be timely anyway, and now I even avoid Chen Hongyang because I’m afraid he’ll bring up this issue with me, which should actually go to Old Chen as it’s not my responsibility."
Xu Hui joked, "Well, you used to be the firefighter, and now that you’re the deputy director, you should definitely handle these emergency cases well."
"Seasonal changes are when children are prone to illness. The more children gather, the higher the risk of cross-infection and the more restless their emotions can get."
"At that time, just do your best to assist, see patients registered under you when you can. Even though our Second Hospital’s pediatrics can’t compare to specialized hospitals’, it holds a certain reputation among comprehensive hospitals."
"You’re going to establish pediatric surgery anyway, so put in the extra effort. The sense of achievement in treating children is higher."
Liu Banxia rolled his eyes, only seeing the achievement from curing the disease, but no one was addressing the hardships of treating children.
The same symptoms in children exhibit "vastly different" conditions, as they can’t clearly express; a simple "stomach ache" could mean anything.
He came to chat with Xu Hui to avoid major directional errors with Huang Bo. Xu Hui gave his approval, and Liu Banxia felt relieved.
Walking out of internal medicine, he saw Liu Yiqing still sitting at the computer, engrossed in reading. He wouldn’t interfere; the more knowledge one has, the more comprehensive explanations can be given to patients.
"How’s it going, still listless? What’s the patient’s decision?" Liu Banxia asked as he saw Li Hao coming over.
"His thoughts have reverted. He wants to continue his lithium carbonate treatment following his own standards," Li Hao replied with a bitter smile.
"He said he’s become like a madman and has lost interest in working. He just wants to be a normal person in the remaining time and go traveling, to see some scenery."
"What about his family?" Liu Banxia asked.
"He refuses to involve his family, which is troubling for me," Li Hao said.
"Teacher Liu, I’m unsure what to hope for him now. After witnessing his mania today, I’m regretting the advice I gave him."
Liu Banxia patted his shoulder, "We can provide suggestions, but the ultimate decision is in the hands of the patient. Before discharge, we also thought he would continue medication without tapering off."
"He wants to give himself more options and attempts. Whatever decision he makes now, we should support him. Don’t carry too much burden or feel torn."
"I feel that if he doesn’t try, when his kidneys are irreparably damaged, he might regret not attempting a medication reduction."
"He’s tried now, so whatever decision he makes, he won’t regret it in the future. Regret is the hardest thing in life, that feeling is unpleasant."
Li Hao nodded, knowing it’s the truth, yet he still felt conflicted over this particular patient.
He envied Huang Bo a bit; the patient with intestinal fermentation syndrome repeatedly admitted but became semi-recovered after fecal transplant treatment.
While his patient, after a second admission, had to make such a choice. One option was a happy early death, and the other was a mad late death.
He wished he could help more, but couldn’t offer the aid because this patient’s situation was unchangeable, beyond even divine intervention.
