"Xu Qiu, you didn't find out the reason?" Wang Ping asked.

Xu Qiu shook his head: "I have no clue."

Wang Pingsisuo said: "The most common thing is nitrite poisoning, and there are a lot of news about mistakenly eating industrial salt every year."

"It has nothing to do with salt."

Wang Ping understood the subtext, and it had nothing to do with pickled food.

He thought about it and said, "Spoiled vegetables may also contain excessive nitrite."

Xu Qiu had already considered these factors, and he frowned and said, "It is more likely to be drug factors, such as local anesthetics, or dapsone."

Dapsone is a drug that is mainly mentioned in textbooks, but clinicians find it very unfamiliar.

The reason is that it is rarely used now, which means that medical students see more often during exams.

Xu Qiu continued: "Local anesthetics are not considered, and the patient has no chance to get in touch with these things."

Regulated drugs are not seen by ordinary people.

"Daponesulfone? I'm familiar with this. When I was in the infectious department, I met a leper patient and happened to use this medicine!" Wang Fan raised his hand with a proud expression.

Xu Qiu was slightly surprised.

Dapsone is indeed the medicine used in the infectious department, and the main symptomatic disease is leprosy.

However, since leprosy is rare, dapsone is rarely prescribed. Many of the drugs that expire every year are dapsone.

Wang Fan stood up and said, "Brother Xu, leave it to me to ask."

Xu Qiu estimated that the breakthrough point was the medicine, which was not very difficult, and he had surgery in the morning, so he agreed.

At noon, Xu Qiu, who had finished the operation, returned to the office.

Not long after, Wang Fan came to report on the situation.

"Brother Xu, I asked, the patient has never had leprosy."

"Just ask about leprosy?"

"Of course not. Dapsone is also a drug for preventing and treating pneumocysticosis in AIDS patients. Although it is a third-line drug, trimethoprim and sulfamethoxazole are used clinically, I still asked them all, but the patient did not meet them."

All four preoperative items were performed, and Jiang Qiang did not have these infectious diseases.

Wang Fan spread his hands and said, "But the patient's medical history is not perfect enough. She fell into a coma yesterday, so she didn't find it. But when I woke up this morning, I went to check it out and found that the patient still had some dermatitis. Brother Xu, do you think you should prescribe some medicine?"

Xu Qiu frowned immediately.

The patient's family was really careless... He asked repeatedly yesterday, and there was no other problem except for diarrhea. He found the omissions this morning when the rounds were inquired.

"Go and have a look in the afternoon." Xu Qiu said.

What he is more concerned about now is why it induces methhemoglobinemia.

According to his guess, the medical history he had asked about before can basically rule out the cause, leaving only the drug-induced item.

If it is not dapsone, some drugs that treat malaria, urethritis and red urine can also be caused.

But Wang Fan also asked by the way, and he also got a negative answer.

Xu Qiu called out Jiang Qiang's medical record page and slowly slide it to view it.

Suddenly, he looked at Wang Fan.

"You said the patient has dermatitis and still has diarrhea?" Xu Qiu asked.

Wang Fan was a little confused, so he said: "Yes, I also asked, the patient applied erythromycin ointment himself."

"How long has it been?" ωωw..net

"It seems to be about four days."

"Isn't it done yet?"

"Yes, I probably don't have folliculitis or suppurative skin disease, so let Brother Xu go and have a look and prescribe the right medicine." Wang Fan is just an emergency doctor and doesn't know much about dermatology diseases.

But Xu Qiu was keenly aware that something was wrong.

“What did they eat for lunch?”

Wang Fan was stunned for a moment: "Is this important too?"

Xu Qiu nodded and stood up to go to the ward.

It was just the meal time, and the patients in the same ward had already started eating, but Jiang Qiang was still lying on the bed, and her husband disappeared.

"Aren't the family members here?" Xu Qiu glanced at him.

Jiang Qiang thought it was the ugly doctor in the morning again, so he responded listlessly, but after subconsciously glanced at Xu Qiu, he sat upright.

Wang Fan:???

Should it be so realistic?

Xu Qiu put on his gloves and said, "I need to check individuals, please cooperate."

"Okay!" Jiang Qiang didn't say anything.

"You have a rash?"

"There are several places, including underarms, chest, and butt..."

"No, no need to take off your clothes." Xu Qiu stopped her face without changing.

Wang Fan silently pulled Shi Lian over... If there was no medical staff of the opposite sex present, he was really worried that Xu Qiu would be killed.

After Shi Lian arrived, she helped Jiang Qiang pull up her clothes.

Xu Qiu looked closely.

Groups of blisters grew under the patient's armpits, arranged closely, covering the skin like a map, with different shapes and sizes, the largest one was about two centimeters.

Each blister is connected into pieces, and the surrounding skin is red and swollen.

At first glance, it looked like fine and dense fish scales, but the patient's fish scales were blisters next to each other.

Xu Qiu tried to press.

The blisters are firm in texture, and from the surrounding intact blisters, they are not prone to rupture, otherwise they would have been eroded in patches due to the wear of the skin.

"Is itchy?"

"Itchy! Every time I can't help it, I will take a cold shower. I can't help it anymore, so I apply some erythromycin ointment."

"Does it hurt?"

“Sometimes it hurts!”

Xu Qiu nodded, and he probably knew it.

Wang Fan said in surprise: "Isn't this an ordinary infection?"

"no."

After Xu Qiu finished speaking, he added: "Do a skin biopsy and a small intestine biopsy."

Wang Fan and Shi Lian were stunned at the same time.

Why do intestinal examinations for skin problems?

Is it possible that the patient's diarrhea has another reason!

...

Soon, the patient's examination report came out.

Skin biopsy shows that the patient has a microabscess around the capillaries on the top of the head, and there is aggregation of neutrophils and eosinophils, and the subepidermal blisters can be seen in the blisters, and there is also infiltration of eosinophils and neutrophils around the blood vessels in the dermis...

Abnormalities were also found in small intestinal biopsy.

Jiang Qiang's intestinal epithelial appearance has undergone mild atrophy, and the lymphoid histocellular nucleus and plasma cells in the inherent membrane have also infiltrated!

"Herpetic dermatitis?" In the laboratory department, Dr. Gu hurriedly sent him over when he saw Xu Qiu's patient's results.

I met Shi Pity on the way.

Shi Lian immediately thought of herpes dermatitis.

This is an immune disease with unknown cause, with genetic susceptibility and is very rare in clinical practice. Its main manifestation is a pleomorphic rash mainly composed of blisters. The rash is often accompanied by severe itching, occasionally burning pain, and a small number of them are also accompanied by diarrhea, abdominal distension and other digestive tract symptoms.

If you are not an experienced doctor, you may misdiagnose eczema and delay the treatment time.

Seeing this report, Shi Lian was immediately in trouble.

My teacher wanted to find the cause of methhemoglobinemia. Why did she find herpes dermatitis after checking?

Now not only is methoglobinemia unexplainable, but also herpes dermatitis with unknown causes!

——
Chapter completed!