It got through the patient's primary care doc (who had never heard of it), a dermatologist, and an infectious disease specialist. And Happy made the diagnosis.
I made it in less than 15 minutes after reviewing the chart on my first visit with the patient and then talking with him for just one pointed question.
"Have you ever had staph infections growing up?" I asked.
"Yes, I used to get them all the time", he said.
My patient, a 20's young male, presented with spontaneous osteomyelitis (bone infection) of the spine. A crazy diagnosis in a non IV drug abusing patient. It just doesn't happen unless you are immune-suppressed.
Job's syndrome. Something, that for what ever reason, sticks in my knowledge base dating back to my med school days. Job's syndrome. What the hell is that you ask?
Recurrent staph infections associated with asthma, eczema, eosinophilia and elevated IgE levels.
In the back of my mind, I associate Job's syndrome with recurrent staph abscess and eosinophila. So when I saw the chart, saw the 30% eos in the blood I knew I had the diagnosis. My patient also had asthma and eczema. All that was left was to check an IgE level. And sure enough, a week later it came back more than 20 times normal.
I told the primary doc what I thought he had. He had never heard of it. "I'll have to read about that", he said. Well, unfortunately, there is no treatment and no cure. Only good hygiene and preventative measures to keep from getting infections.
I gotta say, as an internist, with all the horses running around, the occasional zebra sure kicks it up a notch on the excitement level. Never did I think a Job's syndrome would land in my lap, and I would make the diagnosis without even flinching. I impressed myself that day. That med school thing sure accounted for something, I guess.
I made it in less than 15 minutes after reviewing the chart on my first visit with the patient and then talking with him for just one pointed question.
"Have you ever had staph infections growing up?" I asked.
"Yes, I used to get them all the time", he said.
My patient, a 20's young male, presented with spontaneous osteomyelitis (bone infection) of the spine. A crazy diagnosis in a non IV drug abusing patient. It just doesn't happen unless you are immune-suppressed.
Job's syndrome. Something, that for what ever reason, sticks in my knowledge base dating back to my med school days. Job's syndrome. What the hell is that you ask?
Recurrent staph infections associated with asthma, eczema, eosinophilia and elevated IgE levels.
In the back of my mind, I associate Job's syndrome with recurrent staph abscess and eosinophila. So when I saw the chart, saw the 30% eos in the blood I knew I had the diagnosis. My patient also had asthma and eczema. All that was left was to check an IgE level. And sure enough, a week later it came back more than 20 times normal.
I told the primary doc what I thought he had. He had never heard of it. "I'll have to read about that", he said. Well, unfortunately, there is no treatment and no cure. Only good hygiene and preventative measures to keep from getting infections.
I gotta say, as an internist, with all the horses running around, the occasional zebra sure kicks it up a notch on the excitement level. Never did I think a Job's syndrome would land in my lap, and I would make the diagnosis without even flinching. I impressed myself that day. That med school thing sure accounted for something, I guess.
props
ReplyDeleteSounds like an episode of House...
ReplyDeleteNice call House.
ReplyDeleteooo ooo! Did the patient have retained primary teeth as well??
ReplyDeleteVery Cool!
ReplyDelete"When you hear hooves, think zebras, not horses".
I am sure they learn about Job's syndrome in Dr. Nurse school! Nice zebra.
ReplyDeleteNice job... er Job.
ReplyDeleteHeh