l.georges online

Here is a simplified version of the document : McNeil, Julian. “Complete heart block in a Caucasian woman with Behçet’s disease: a case report.” Journal of medical case reports 10.1 (2016): 1.

This case concerns a 48 year old Caucasian woman who was hospitalized for lightheadedness, muscular weakness, blurred vision, feeling faint, and feeling sick, with an abnormal heartbeat. Doctors carried out an electrocardiogram to visualize the heartbeat which showed that the electrical signals were not being correctly transmitted between the chambers of the heart. This explained the woman’s symptoms, and because it can be fatal doctors fitted a pacemaker and the symptoms disappeared. They then checked the the levels of a protein called troponin were normal and this allowed them to conclude that there was no damage to the heart muscle.

The woman subsequently suffered from frequent watery diarrhea, and said that she had regularly had painful ulcers on her mouth and genitals over the previous 10 months, and sometimes complained of swollen and tender joints, as well as a period of redness in her eyes that lasted two weeks. She had been to hospital 3 weeks earlier for chest pain due to an inflammation of the heart muscle, and tests showed a normal heartbeat with signs of fluid around the heart. She had a swollen right knee, and ulcers inside her mouth and on her vulva. She was a relatively heavy smoker, and when pregnant with her second child she had suffered from a blood clot in her right leg.

Doctors found no signs of bowel disease, or of skin injuries that were resistant to healing, and all tests for diseases where the body’s immune system attacks healthy cells were negative. They then tested for certain substances in the blood and the stools which might cause an immune reaction. An internal examination of the digestive system uncovered an ulcer in a part of the intestine often associated with another disease, but which was not consistent with that disease. Further tests showed inflammation of the blood vessels, but enabled doctors to eliminate the disease. Based on the woman’s ulcers, inflammation of the membranes in her joints, the ulcer in the digestive tract and her episode of inflamed eyes, doctors diagnosed a disorder named Behçet’s disease (BD). She was prescribed a drug called predisnalone to treat the inflammation, gradually decreasing the dose, and another called sulfasalzine to treat her diarrhea. Symptoms had disappeared at her follow-up appointments one and three months later.

Doctors made their diagnosis of BD on the basis of the woman’s symptoms after eliminating other possible causes. Although they did not find any long standing skin injuries, a symptom associated with BD, its absence is not enough to rule out the diagnosis. This case is interesting for a number of reasons. First of all, BD is more often found in men than in women, and secondly it occurs more frequently in regions along the Silk Road. Thirdly, despite the fact that heart problems are known to occur in BD, and that problems with electrical signals in the heart, known as heart block have already been recorded in BD patients from a non-Caucasian background, this is the first time heart block and BD have been reported in a Caucasian woman.

The fact that the levels of the protein called troponin, were normal, and that the heart muscle was in good condition led the doctors to eliminate other possible causes of heart block, and this was confirmed by the normal electrocardiogram when she was first in hospital. Therefore the doctors concluded that the heart problems were likely caused by Behçet’s disease. This led them to recommend that when BD is diagnosed, heart-related problems should be considered, even when the treatment for other aspects of the disease seems to be working, since heart block can be fatal.

In this session you will discover the case report, and working from a sample, your task will be to simplify it.

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A correction will be posted online before the end of the week.

You also need to start thinking about sending me the pdf of the case report you would like to present.  This will be your task for the next session, so you can start thinking about subjects that interest you.

• No two people may present the same case, so it is first come, first served.
• Do not send a research article, make sure it’s a case report.
• You should have sent me a proposed case by the end of this month.

Today’s document is here : TD5
Practical work on the consultation is today’s subject.

Next week we’ll be moving on to the Case Report.

For now, here’s a bonus link to a fascinating podcast that has short episodes which are very varied and often intriguing.