"CRRT treatment continues, immunotherapy is put on for a while. Sun Lien returned to his office, and after correcting his instructions, he whispered to Dr. Pascal, "Old Pa, you come out with me." ”

"What's wrong?" In the office of the director of the Comprehensive Diagnostic Center, Dr. Pascal handed Sun a cup of hot cocoa, "You don't look good. ”

Sun Lien sat on the sofa and rubbed his face, trying to organize the language. But he soon found himself frustrated that he couldn't find a suitable interface to ask an immunologist a question.

Why is there such a contradictory explanation in the status bar? Why is a patient with SLE who starts at least 8 points considered to be quiescent? Sun Lien had too many questions in his head, but there was no way to ask.

"I ......," Sun Lien sighed and asked, taking another sip of hot cocoa, "I feel something is wrong." ”

"Feelings?" Dr. Pascal asked, frowning slightly, rubbing his ginger hair, pondering for a moment, "is it a diagnosis?"

"I can't tell. "At this point in the play, you can't suddenly put down the cup and leave. Sun Lien continued to perform, "I always feel ...... His SLE and course of the disease were somewhat out of step – although the diagnosis of SLE should have been correct. ”

"Fifty percent of patients will present with renal impairment or renal insufficiency in SLE. Dr. Pascal seemed to value Sun's "feeling that something wasn't right," and he struggled to dissect what might have gone wrong. "It's okay for vasculitis to cause three lesions, after all, his blood lipids are not high. ”

"If it's vasculitis caused by SLE,......" Sun Lien keenly grasped a point that might develop a topic, "It should be systemic, right?"

Vasculitis caused by systemic lupus erythematosus does not have a common area, but can affect blood vessels in many locations — more often lupus vasculitis occurs on the surface of the body and at the ends of the limbs. Large amounts of immune complexes can deposit and block tiny blood vessels at the end of the limb, leading to gangrene or simply limb necrosis.

And Wang Ge's body surface is normal, and there is no appearance of any vascular lesions at all.

"He also didn't report that he had a Reynaud reaction and no limb pain...... He had no symptoms of vasculitis. The more Sun Lien spoke, the smoother his train of thought became, "His immune complex is so smart that it only blocks his coronary arteries? ”

"It's a doubt, but it's not entirely impossible. Dr. Pascal nodded, then shook his head again, "Systemic lupus erythematosus is a very strange and volatile disease. Although the general direction of the lesion is similar, the specific symptoms are very different. And everyone's situation is different, maybe there are other reasons why this patient's coronary arteries are more likely to become clogged – such as congenital malformations?"

"The imaging has been done and is normal. Sun continued to sort out his thoughts, he had to make Dr. Pascal realize that something was wrong. "And this renal insufficiency is also a little questionable. If he does have lupus vasculitis, then there is about an 80% chance that he will develop lupus nephritis — the kidneys are very sensitive to blood perfusion and autoimmune diseases. In this case, his kidney damage seemed to manifest itself a little too slowly. ”

Dr. Pascal was successfully led astray by Sun Lien. He also began to hesitate a little, "This...... It's a bit weird indeed. ”

"That's why I've been a little uneasy. Sun Lien breathed a sigh of relief, he finally said the most important thing, "The patient's C3C4 complement is low, antinuclear antibody positive, proteinuria, and the diagnostic criteria for systemic lupus are three matched. There is basically no problem in diagnosing systemic lupus erythematosus. But now his symptoms and course of the disease do not match SLE. ”

That's where the contradictions come in. Lupus erythematosus in the quiescent phase does not cause these symptoms.

"That means ......," Dr. Pascal and Sun said in unison, "there are other problems that are causing these symptoms!"

"What diseases cause coronary artery inflammation, proteinuria and ...... at the same time Mental symptoms?" Sun Lien thought about it, but still added mental symptoms. He really didn't think a national level lifter could find a girlfriend – and still have such a good relationship.

Dr. Pascal mused for a moment, "If you were to ask me, my answer would be Wegener's granulomy. ”

Wegener's granuloma is the old name for granulomatous vasculitis, which is an autoimmune disease. Occasionally, the lesion affects the large arteries, mainly the upper and lower respiratory tract and kidneys. At the same time, the disease can also cause neurological lesions.

"Very few patients with Wegener's granuloma first present with psychiatric symptoms, but about one-third of patients develop neuropathy as the disease progresses—although peripheral neuropathy is the most common, it is true that the central nervous system may be affected as well. This can cause psychiatric symptoms. Dr. Pascal took a sip of his coffee, "If it's Wegener's granulomatosis, then the patient will most likely have the same oral and nasal symptoms as SLE...... This diagnosis is troublesome. ”

Symptoms are not typical of SLE and granulomatous vasculitis, because they are autoimmune diseases, and even biochemical features are basically the same. There aren't many ways to be able to tell the two apart thoroughly. This also leads to the fact that most patients with granulomatous vasculitis are extremely difficult to diagnose - the average diagnosis time of this disease is as long as 5~15 months, and even 10% of patients take 5~10 years to be diagnosed.

"Give him a CT scan to see if there are any lesions in his lungs, and then take samples from the kidneys and bronchial lining for biopsy. Sun Lien made a decision, "I'll ask the ulcer question again......"

"Your treatment plan at the beginning needs to be adjusted a little bit. Dr. Pascal adds, "Early treatment is essential for patients with Wegener's granulomatosis. The sooner they start hormonal and immunosuppressive therapy, the longer they will survive – and the prognosis is worse without systemic therapy. ”

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"Ulcers? I have them right now. In the ward, Wang Ge heard Sun Lien's question and answered directly, "I saw it when I looked in the mirror yesterday, but it didn't hurt." ”

Sun Lien looked at Wang Ge's own broken lips, it was indeed an ulcer, yes. "Have you ever been in a similar situation before?"

"Aren't you spying on me? don't you know?" Wang Ge, who had just cooperated, was sick again, "I don't know anything, why did you come to ask me why?"

"Don't mess around!" This time it was Wang Ge's girlfriend's turn to be unable to listen, "How do you talk to the doctor?"

"Oh, what's the hurry?" Wang Ge still looked inappropriate, "It's just an ulcer, look at you like this, what can happen to this?"

Sun Lien coughed lightly and said to Wang Ge's girlfriend who looked shocked and incredulous, "He...... It wasn't like that before, was it?"

"I've never seen him like this. Wang Ge's girlfriend shook her head and replied, she looked disappointed, "I just went abroad for an exchange once, and it's only been three months." He...... That's what he became. ”