Doctor: It's reasonable to perform surgery on yourself.

Xu Qiu opened Wei Ding's eyelids.

"Take a closer look." He illuminated it with an ophthalmic flashlight and said to everyone.

Wang Fan subconsciously said: "Is there... any eye pus?"

"..."

Liu Susu clenched her small fists, holding back her anger and said: "Wang, get out!"

Wang Fan immediately shut his mouth.

Director Shen came closer and observed carefully for a moment, his pupils narrowed slightly: "The eyes are very dry."

Normal people's eyeballs are moistened by tear glands, and there should be a layer of water film on the surface.

But Wei Ding was different. His eyeballs were like mummies that had just walked out of the desert, with almost no moisture.

"besides."

Xu Qiu then separated the patient's upper and lower lips.

Suddenly, a stench hit me.

Xu Qiu's breath was stagnant. This was the drawback of a master's ability to distinguish scents.

"The bad odor in the mouth is probably just a matter of not paying attention to oral hygiene..."

As soon as Director Shen finished speaking, his voice suddenly stopped.

As Xu Qiu continued to open his lips, he saw the patient's oral mucosa that was dry and cracked into pieces.

"Dry eyes and mouth?" He looked at Xu Qiu in surprise.

This is tear gland and salivary gland disorder.

Just...how does this relate to the previous two diagnoses?

Director Shen pondered for a moment, and suddenly an idea flashed through him. He excitedly stepped forward to check Wei Ding's skin.

But he was disappointed.

"There is no butterfly-shaped erythema, and no hair loss, alopecia areata, etc. can be seen. It doesn't look like lupus erythematosus..."

Xu Qiu nodded, and then said: "Half right."

"half?"

"The direction is right, but the patient is lupus erythematosus."

"how to explain……"

Xu Qiu threw the gloves into the trash can and said calmly: "Dry mouth and eyes are caused by systemic lupus erythematosus that affects the lacrimal and salivary glands.

The ‘perinephric fascial thickening’ and ‘mild exudation’ in the previous CT report are not interference items. They are precisely manifestations of renal involvement. "

Director Shen was stunned for a few seconds, then surprise welled up from the bottom of his heart.

In this case, all the abnormalities in the admission examination will be connected!

At first, they thought that the thickening of the perirenal fascia and mild leakage were due to inflammation of the kidneys or the possible presence of stones. Now they are re-examining it. If lupus erythematosus is involved, whether it is dry eyes, dry mouth, or perirenal Abnormalities are most likely multi-system involvement caused by lupus!

"But...three illnesses?"

The chief minister looked a little confused.

Focal epilepsy and transverse myelitis are troublesome enough, add lupus erythematosus...

Isn't this diagnosis a bit too abrupt?

However, at this moment, Director Lin, who had always been silent, suddenly patted Wang Fan on the shoulder.

boom!

Wang Fan turned his head in horror, "Director Lin, what are you doing?"

"I know what Dr. Xu means!"

Director Shen was stunned for a moment. He looked at Wei Ding and reacted the next moment. He patted Shen Wangfan on the other shoulder: "I understand too!"

Wang Fan:? ? ?

Liu Susu said quietly: "Let you go out."

After a brainstorm, Director Lin felt a sense of relief as he suddenly understood. He and Director Shen looked at each other and said in unison: "Lupus brain!"

Lupus brain.

As soon as these three words came out, the doctors present were surprised.

This is a rare disease. To put it bluntly, it is systemic lupus erythematosus combined with damage to the central system and peripheral nervous system.

It is difficult to diagnose clinically.

Because the disease has too many clinical manifestations and is not specific at all. If you want to do an examination, it will be difficult to diagnose unless you take a biopsy of the lesion and find the formation of immune complexes or find evidence of direct damage to cells...

In terms of classification, there are several types of rough distinctions.

For example, nonthrombotic neurological lupus is characterized by vasculitic lesions.

There are also thromboembolic, hemorrhagic, etc...

Director Shen said solemnly: "What Dr. Xu means is that these three diseases are actually lupus brain!"

Director Lin nodded.

There are many clinical manifestations of lupus brain, including epileptic seizures, muscle weakness, and damage to the kidneys, salivary glands, and tear glands.

At this moment, everyone finally realized.

Looking back on the entire diagnosis and treatment process, they felt a sense of powerlessness that was beyond their reach.

In front of Xu Qiu, the disease seemed to be divided into several stages. First, it was focal epilepsy, then transverse myelitis, and then based on dry mouth and eyes + perirenal damage, it pointed to lupus erythematosus. Finally, the common logic of the three diseases was found - — Lupus brain!

However, they still focus on the one-to-one correspondence between symptoms and diseases, without thinking of the whole.

In other words, they made the association, but their clinical experience and intuition were not enough to support such complex reasoning.

Director Shen and Director Lin breathed a sigh of relief at the same time, with cheerful smiles on their faces.

Following Xu Qiu's diagnostic ideas, they also felt the process of a disease from onset, to development, and finally to solving the case. All the links were closely linked, and the final disease was locked like a cocoon...

This isn't about diagnosing a disease, it's simply about enjoying it!

…

Under the guidance of Xu Qiu, Director Shen, Director Lin and others finally came to the final conclusion.

Lupus brain is also Xu Qiu's judgment.

Except for this disease, nothing can explain Wei Ding's problems at the same time.

After returning to the conference room, Xu Qiu gave a more detailed analysis.

"Lupus encephalopathy, also known as neuropsychiatric lupus, is extremely dependent on the experience of the diagnosing doctor to make a diagnosis.

Of course, there are also indicators for reference.

In the first five years of lupus onset, the incidence of cerebrovascular accidents is very high. If the patient has unexplained rashes, fever, or multiple system involvement, plus a multiple cerebrovascular accident, lupus encephalopathy can be considered.

In addition, if lupus encephalopathy is suspected, one more indicator needs to be focused on.

Antiphospholipid antibodies are positive!

Although no one can explain the pathogenic mechanism, many literatures and clinical data show that patients with positive antiphospholipid antibodies are more likely to develop...

In this disease, the manifestations of lupus encephalopathy include epilepsy, transverse myelitis, fever, etc.

In addition to these, the most diagnostic value for this disease also includes mental symptoms, stroke, transient ischemic attack and aseptic meningitis..."

After the lecture, Director Shen and others felt enlightened.

For them, Wei Ding's disease was a fog.

Xu Qiu helped them dispel the fog, and taught them how to dispel it and where to dispel it... This lecture is priceless!

From now on, when encountering lupus brain, Lin Yishen Internist should be very confident.

Before leaving get off work, Xu Qiu arranged a detailed immune system test for the patient.

Before the results come out, considering the patient's condition, treatment must be given first.

Brain involvement is enough to show that the condition is serious.

In addition, the patient has kidney disease, which raises the severity.

The emergency room and ICU are well prepared to deal with the possible lupus crisis of Wei Ding at any time.

If the condition is controlled and does not continue to progress, everyone will be happy.

The most worrying thing is the occurrence of lupus crisis!