Sun Lien doubts SLE, not that he suspects that Kaoru Kobayashi's gender is problematic. After all, the status bar has made it clear that this is a man. Although SLE is more common in women of childbearing age, it is also common in men.

The main reason why he suspects Kaoru Kobayashi has SLE is based on the inference made a year ago and the current course of the disease. Although this probability is very low - if the status bar really missed the diagnosis or Sun Lien himself incorrectly deduced the cause of hyperthyroidism, then Sun Lien now has reason to associate Kobayashi's symptoms with the hyperthyroidism crisis a year ago.

In the treatment of hyperthyroid crisis, in addition to actively maintaining the patient's vital signs, the only way to completely eliminate the threat of hyperthyroidism to the patient's life is to take iodine-131 treatment or surgical removal of part of the thyroid gland. Kaoru Kobayashi was treated with iodine-131 at the Fourth Hospital, and during an hyperthyroid crisis, he was also treated with hormones and iodine in order to stop Kaoru Kobayashi's thyroid gland from secreting excessive thyroid hormones as soon as possible.

Excessive iodine intake can suppress thyroid secretion. Excessive use of hormones can suppress both the thyroid gland and Kaoru Kobayashi's immune system.

If he had already had a systemic immune disease such as SLE at the time, it was possible that his symptoms would have improved or even appeared to have recovered with hormone therapy.

Sun Lien pondered this, and the cold sweat on his back was about to come out. It's okay not to think about it, but the more he thinks about it, the more he thinks it's really fucking a missed diagnosis.

Even if it is true, this complex and atypical missed diagnosis of SLE is completely normal. But Sun Lien still felt very unstable in his heart. It feels like the night when Sun Lien rode a bicycle as a child, accidentally smashed the neighbor's uncle's flower pot, and then hid home.

"In short, when we get a consultation, we must take this into account. Liu Tangchun specially called Sun Lien to a place where no one was supposed to teach face-to-face, also to remind his students to try to look at this patient with broader eyes and thinking. He was indeed worried that Sun Lien's diagnosis was negligent at the beginning. And if this omission does exist, then treating the previous symptoms separately from the current symptoms will inevitably lead to missed diagnosis or even misdiagnosis again.

Once other trainees were even hospitalized and misdiagnosed, Liu Tangchun was naturally the first to spare them. But Sun Lien is different...... In all fairness, it is not easy for a young doctor who has not even completed the training to encounter such a complex case and think of hyperthyroidism instead of following Xu Yourong's advice when he sees bleeding and emotion. Even if Sun Lien really missed the diagnosis, Liu Tangchun would only say two words at most, such as "pay attention next time", and forget it.

I hope that Kobayashi will not be angry because of the possible missed diagnosis...... I hope he doesn't backhand and ask the four hospitals to pay for that diagnostic center.

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After a year, Sun Lien saw Kaoru Kobayashi and his wife Lin Lan again. His first impression was that Kobayashi was ...... It seems to have gained a little weight.

"Dr. Sun. After Lin Lan saw Sun Lien, she stood up a little excitedly, she was very impressed by this young doctor - after all, the old lady kept chanting in front of her, "Doctor Sun is your life-saving benefactor". Coupled with Sun Lien's seriousness to ask about his situation almost every day, Lin Lan unconsciously had a little more trust in Sun Lien, "I'm going to trouble you again." ”

"It's true. Sun Lien smiled bitterly and nodded, "If I can, I really hope I will never see you again." ”

It is really not rude for doctors and patients and their families to say "never again". Rather, there is a deep expectation of doctors that patients will be healthy and away from the hospital.

But since it's already here, you can't blow people away. Sun Lien sighed and picked up the inspection report that had just been released not long after it was released from the bedside.

Leukocytes 14.01×10^9/L, hemoglobin 87g/L, procalcitonin 0.385ng/ml, C-reactive protein 226mg/L.

Sun Lien immediately identified the anomalies in the report, especially the two indicators of procalcitonin and C-reactive protein - the laboratory on the Daishan Island used an anti-sandwich immunochemiluminescence method, and the reference value was 0.1ng/ml. Kaoru Kobayashi's indicators directly exceeded nearly four times. C-reactive protein, on the other hand, is about three times exceeded.

Seeing this inspection report, Sun Lien's guilt suddenly eased a lot. This indicator does not look like SLE at all, but rather as the result of some kind of infection.

"From this data, it looks like some kind of infection. Sun Lien explained to Lin Lan, "When did he start showing symptoms?"

"I had a few fevers in the past few months, but I was fine with fever-reducing medicine. Lin Lan recalled for a moment and replied, "It's as serious as this one...... There has never been one in the past. He started to have a fever yesterday and the ship's doctor gave him some antibiotics and fever reducers. But today I still have a fever. ”

Sun Lien took out a small notebook and a pen from his pocket, and began to record the medical history he asked, "In addition to fever, weakness, cough and ......" He glanced at the top of Kaoru Kobayashi's head, and then continued, "Are there any other symptoms besides rash and lymphoma?"

"Kaoru Kobayashi, male, 25 years old, significantly active bone marrow hyperplasia, elevated C-reactive protein, fever, cough, rash, positive antinuclear antibody, positive antiphospholipid antibody, positive anti-β2-GP1-Ab antibody. ”

Although he didn't look carefully at the duration of the back, Sun Lien didn't have the time to care about those things. The three antibody positives in the back made his hands tremble slightly.

The first positive antinuclear antibodies are usually present in patients with autoimmune diseases, tumors, and thyroid diseases. The latter two antibodies mostly indicate that the patient may have antiphospholipid syndrome (APS).

And when antinuclear antibody positivity and antiphospholipid syndrome (APS) come together, systemic lupus erythematosus (SLE) should be the first thing that comes to mind for every qualified internist.

Antiphospholipid syndrome usually follows other autoimmune disorders, especially in patients with SLE. It is not impossible to occur alone, but the isolated occurrence of APS does not directly lead to a positive antinuclear antibody reaction.

Sun Lien looked quite calm on the surface. But deep down, there were constant doubts about himself, "Is there really nothing wrong with your previous diagnosis?" "Kaoru Kobayashi and his father have a discordant relationship, but is it really discordant to the point where it can cause thyroid problems?" "If the previous treatment didn't use hormones, would he have died because of your misdiagnosis?" "Did you do it right?"

Sun Lien, who was shaken in his heart, suddenly felt some chills on his body. The feeling that he used to look down on with the help of the status bar, no matter what incurable diseases he could see, has completely disappeared. He felt as if he was in Antarctica, and he had been stripped naked and thrown into the wild. Chills in the body, chills in the bones, and even ...... I was also chilling in my heart.

There is no fault in the status bar, and the only one who makes the mistake is yourself. Sun Lien was chilled, and he began to constantly recall the patients he had diagnosed before. Is there any suspicion about the cause of those patients? Is there anything that could have been wrong? Will there be people who have delayed treatment because of their own diagnostic errors? or even ...... Paid with lives?

Sun Lien was constantly immersed in his own self-doubt, unable to extricate himself. I didn't even listen to what Lin Lan said later. And Lin Lan keenly discovered Dr. Sun in front of her...... There seems to be some absent-mindedness.

"Doctor Sun?" she cautiously called Sun Lien twice, but all she got was Sun Lien's somewhat perfunctory "uh-huh" answer. After concluding that Sun Lien really didn't listen to herself, she tugged on Sun Lien's sleeve a little angrily - this really can't help but be angry, her husband is lying on the bed suffering from illness, and Dr. Sun is absent-minded, where is this?

"Ahh "I'm sorry......" Sun Lien apologized to Lin Lan with a little weakness, "I ......" He was trying to use his brain to find an excuse for his distracted behavior. Lin Lan sighed and took the initiative to relieve him, "I heard that Doctor Sun, you also just got on the boat today." I'm really sorry to trouble you to see a doctor for Kobayashi. ”

Sun Lien responded embarrassedly, and decided in his heart that even if it was a big thing, he would have to wait until he saw Kaoru Kobayashi's illness - dwelling on the past would not help the current situation. Before dwelling on the lives of others, you must first concentrate and save the life of the patient in front of you.

Even if I really got the cause of Kaoru Kobayashi wrong before...... At least I have a chance to make up for it now.

Sun Lien took two deep breaths, and then asked the military doctor on the side, "What equipment is available on the ship right now?"

Every patient on board the ship was received and treated by the military doctor on the Daishan Island. This is someone else's patient, and even if Sun Lien wants to make up for the big mistakes he may have made before, he must obtain permission from the military doctor.

The military doctor who received Kaoru Kobayashi's surname was Jiang, and he was an internist from Yuanhai Hospital. He knew about Liu Tangchun's origins, and after learning that the patient and the patient's family he treated were rescued by Sun Lien's diagnosis a year ago, he immediately became interested in the doctor in front of him who had just obtained his medical license.

Being able to diagnose a hyperthyroid crisis in that situation, and also being able to see at a glance that another patient with severe trauma had internal bleeding is very capable.

"There are two CTs that can be used now, and PET scans can be done. Dr. Jiang replied, "MRI can't be done...... After all, the ship is made of steel. However, the rest of the equipment is basically there. ”

"Do a CT scan of the chest, and then take blood for culture. Dr. Jiang's cooperation was indeed in place, and Sun Lien even mistakenly thought that this was his home stadium. "Let's look at the lungs first. ”

The three antibody positive reaction tests behind the status bar must definitely be done, but with Kobayashi Kaoru's current symptoms, Sun Lien really can't think of any direct reason to let the Daishan Island check these three antibodies. Then you can only start with the symptoms that are currently manifesting.

If you don't look at the three antibody positives at the back of the status bar, then Kaoru Kobayashi's symptoms are a more typical infection. However, the location of the infection is not known – the most likely source of infection is the respiratory tract or lungs, depending on the cough. A CT scan can confirm whether Kaoru Kobayashi's lungs are diseased at a relatively fast pace.

As for bone marrow hyperplasia, it is obviously active...... Sun Lien sighed, if the CT examination of the lungs is basically normal, then Kaoru Kobayashi's problem will be big. Lymphatic swelling, active bone marrow cell proliferation, and long-term recurrent fever...... This is typically a leukemia or neoplastic finding.

Unknown infection that is not sensitive to antibiotics, leukemia of unknown stage and classification, SLE, or an autoimmune disorder that affects the whole body. There are only these three explanations that Sun Lien can think of at present. And it doesn't matter which of them Kobayashi Kaoru is recruited...... I'm afraid none of these can be easily solved by the medical equipment on the Daishan Island.

Sun Lien sighed secretly while communicating with Dr. Jiang about the diagnosis and examination plan. He didn't even know if he should pray that he would have a chance to make amends, or simply pray that this illness had nothing to do with a previous misdiagnosis. In his opinion, Kobayashi Kaoru finally turned back from the ghost gate, and he and Lin Lan had just lived a comfortable life. This makes young people ...... Facing another parting of life and death?

For the first time, Sun Lien began to hate himself for being a doctor. If you don't ...... a doctor At least he won't be so tormented, right?