It got through the patient's primary care doctor who had never heard of it, a dermatologist and an infectious disease specialist before 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. This is a crazy diagnosis in a non IV drug abusing patient. It just doesn't happen unless you are immune-suppressed.
Enter 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 heck is that you ask? Job's syndrome consists of 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 I knew I had the diagnosis when I saw the chart and the 30% eosinophilia in the blood. My patient also had asthma and eczema. All that was left to check was an IgE level. Aweek later it came back more than 20 times higher than normal.
I told the primary doctor what I thought he had. He had never heard of it. "I'll have to read about that", he said. Unfortunately, there is no treatment and no cure for Job's syndrome, only good hygiene and preventative measures to keep from getting infections.
As an internist flea, 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 that I would make the diagnosis without even flinching. I impressed myself that day. If you want to read more about strange medical conditions, Amazon has lots of books about rare diseases
.
"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. This is a crazy diagnosis in a non IV drug abusing patient. It just doesn't happen unless you are immune-suppressed.
Enter 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 heck is that you ask? Job's syndrome consists of 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 I knew I had the diagnosis when I saw the chart and the 30% eosinophilia in the blood. My patient also had asthma and eczema. All that was left to check was an IgE level. Aweek later it came back more than 20 times higher than normal.
I told the primary doctor what I thought he had. He had never heard of it. "I'll have to read about that", he said. Unfortunately, there is no treatment and no cure for Job's syndrome, only good hygiene and preventative measures to keep from getting infections.
As an internist flea, 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 that I would make the diagnosis without even flinching. I impressed myself that day. If you want to read more about strange medical conditions, Amazon has lots of books about rare diseases
. 
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