Alarm in Arm
In the course of the last year, the 24-year-old Japanese operations had to pull to the shoulder under – due to a bone fracture, and due to a so-called bottleneck syndrome (“Impingement”), the shoulder hurts with certain movements strong. After the intervention in Abscesses formed several times on the left Arm, where her blood was taken.
Although the 24-Year-old, who works as a nurse has taken a series of antibiotics, but the complaints are never resolved properly. Instead worsened your condition further, the skin on the left Arm is extensively inflamed. Because of the associated swelling of the tissue can no longer be bled sufficiently, muscles, and nerves could be permanently damaged. Doctors speak of a compartment syndrome.
When the woman consults a doctor, uses of these cuts on the upper and lower arm, removing infected tissue and pus aspirate and to reduce the pressure in the tissue. He will refer you also to the University hospital in Nagasaki, Japan, where the woman imagines the team of Doctors headed by Kazuko Yamamoto.
A first physical examination revealed no other inflammations besides those of the left Arm. The blood values indicate a slight disorder of the liver function and systemic, so the whole-body inflammation.
The woman suffers from may be related to an immunodeficiency? This may lead to actually harmless infections have serious consequences. However, further test, however, speak results. For example, the amounts of the various immune cells in the body of the patient are all in the normal range. In addition, the woman is not infected with HIV, what can cause a immune weakness.
No other foci of inflammation in the body
The Doctors perform several tests, as they report in the “Journal of Medical Case Reports”, and
- a computer tomography of the whole body,
- a magnetic resonance imaging of the spine and heart,
- an ultrasound of the heart by means of a in the esophagus is pushed probe,
- a puncture of the bone marrow.
Nothing provides evidence for further inflammation in the body, or gives clues as to the cause of the disease. The doctors put on bacterial cultures to identify the microbes in the inflamed tissue of the Arm, as well as in the blood. In the blood, among other things, various streptococci, the bacterium Prevotella buccae, and microbes of the genus Mobiluncus are any to be found in the wound tissue against it.
The team of Doctors prescribed the patient on two antibiotics, and the inflammation of the patches promptly. However, a sudden high fever develops again. The woman reported severe pain in the previously inflamed area.
Again the Doctors put a section and discover a collection of pus in a forearm muscle called the Musculus supinator. You give the woman a different antibiotic, analyse what bacteria are found in the pus and adjust the medication accordingly. Unfortunately, the patient is allergic to the new antibiotic, so that the medium needs to be changed.
In addition, the woman receives a so-called hyperbaric oxygen therapy, where for a time pure oxygen is inhaled, which is intended to promote wound healing.
Once again, the woman falls ill
The therapy has. However, an abscess on the left Arm is formed shortly before discharge from the clinic, the patient had again fever.
This makes the team of Doctors so taken aback that it now takes into account that the patient gives their complaints even. The so-called Munchausen syndrome, people play diseases or cause harm to themselves, to certain complaints to trigger.
A psychiatrist is consulted and speaks with the patient and their family. The sister of the woman then searches a pocket of the patient and finds three syringes, one containing a cloudy liquid.
In the laboratory, is shown In this fluid bacteria of the species swim Enterobacter cloacae and Enterococcus faecalis, both species are found in the human intestine. A re-analysis of a pus sample from the patient shows that contained Enterococcus faecalis bacteria from the genome identical with those of the spraying liquid.
This confirms the suspicion that the woman has Munchausen’s syndrome, and infections self-inflicted. Other Details: the patient always seemed the happiest when she was physically ill, and your mood dropped, the better it was for their health.
In the following three weeks, the woman is monitored closely and any new health problems. However, she leaves after that, abruptly, the clinic and tried to take his own life.
Then, you will be trained for a period of time in the closed psychiatric hospital. There you will be told, finally, that she filled the syringe with spit and toilet water, and this liquid in the Arm injected. She said she had felt extremely lonely, as soon as you have received no medical care.
After the patient mentally better after two months, she is released from psychiatry, in the following years, they will be supervised, however, more psychiatric.