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Teamwork is needed to resolve these diagnostic dilemmas. . | Credit: Getty Images
Each week, Live Science highlights an intriguing case report from the medical literature, where we explore unusual symptoms, rare diagnoses, and out-of-the-box treatments. By this”Diagnostic dilemma“, we describe how doctors work to ultimately discover the cause of a patient’s illness. In complex cases, this diagnostic process can be quite difficult. This is part of the reason doctors share case reports: to help other medical professionals who may be facing the same puzzle.
Here are 12 of the most interesting diagnostic dilemmas of the past year. (If descriptions of symptoms and medical procedures make you cringe, proceed with caution.)
1. The boy spoke a foreign language after the operation
A Dutch teenager underwent knee surgery to treat a football injury and after waking up from anesthesia spoke only English – a language he had previously only spoken in language classes at school. He continued to insist he was in the US, did not recognize his parents and could not speak or understand spoken Dutch, his native language. Examinations revealed no neurological abnormalities, and doctors did not initiate any specific treatment to address the language problem. Within 18 hours of the operation, the boy could understand some Dutch but not speak it without difficulty. But then, suddenly, he could understand and speak it normally. The doctors described the event as a strange case of “foreign language syndrome.”
2. The woman without a vaginal opening gets pregnant through oral sex
A teenager presented himself at the hospital with abdominal pain, and shortly after they were examined she revealed that she was nine months pregnant and that she was having contractions. When doctors examined the patient’s reproductive tract, they discovered she had no vaginal opening – a rare condition called distal vaginal atresia. Because of this, the medical team had to deliver the baby – a healthy boy, weighing 2.8 kilograms – by caesarean section. The teenager had been seen at the same hospital about nine months earlier when an ex stabbed her after he found her making out with a new boyfriend. The injuries she sustained during the stabbing allowed sperm to escape her digestive tract and make their way to her reproductive tract, leading to an unlikely pregnancy, her doctors theorized.
3. Man stabbed by a giant fish
A man was taken to hospital by boat and helicopter after he was injured while fishing. Caught a white marlin (Kajikia albida) — a large fish with a long, sharp “beak” — and when he leaned over the side of the boat to free his hook from the fish, it jumped up and struck him. At the hospital, the doctors found a fragment of the fish bulb stuck in the man’s neckspinal canal and the base of his skull. With emergency surgery and antibiotics to prevent infection, the man survived the encounter without any long-term symptoms.
4. Acupuncture has led to joint damage
An X-ray of the front (A) and side (B) of the patient’s left knee. The lines are the tiny golden threads. (Image credit: The New England Journal of Medicine ©2013.) | Credit: The New England Journal of Medicine ©2013.
A woman with osteoarthritis of the knee started getting regular acupuncture when her pain medication started causing stomach problems. But her knees became very painful and she went to the hospital to be examined. X-rays revealed areas of the joints and tibia where bone tissue had thickened and spurs had formed. Additionally, hundreds of small spots could be seen around both knee joints. It turned out that the woman’s acupuncturists had she intentionally left gold threads inside her knees as part of her treatment. In other cases, these threads have caused cysts and tissue damage, which can happen when they migrate through the body.
5. The man is experiencing a rare meat allergy
A Michigan man went to the emergency room with swollen eyelids and an itchy rash and noted that he had also had cramping, nausea, abdominal pain and vomiting in the previous days. When doctors examined the patient, they found signs of anaphylaxis, a severe allergic reaction, and his condition rapidly progressed to shock. The medical team successfully stabilized the patient, but a few days later, his condition worsened again. At that point, doctors noticed a pattern: The symptoms appeared when the man ate red meat. A meat allergy, a condition called alpha-gal syndrome, can be triggered by the bite of certain tick species. It turned out that the man was an avid deer hunter who probably encountered an adult tick or tick larvae while hunting, his doctors concluded.
6. The woman had XY chromosomes in her blood
A woman had her chromosomes checked following a miscarriage to see if there could have been a genetic reason behind the miscarriage. The test showed that, at least in the woman’s blood, her chromosomal profile (or karyotype) was 46,XY – the typical karyotype among men. Further tests showed that in the rest of her tissues, her karyotype was 46.XX, the typical female chromosome profile. The woman had a fraternal twin, so in this case of “chimerism“, the doctors concluded that the XY chromosomes probably came from her brother in the womb, but somehow assimilated them only in her blood cells. The doctors suspected that “the veins and arteries of the two children intertwined in the umbilical cord” at some point. The woman had no obvious symptoms related to carrying these chromosomes in the blood, which led to the birth and led to the birth of a boy.
7. The woman injects herself with black widow venom
A woman visited an emergency room with a headache, severe cramps, and muscle pain, as well as an elevated pulse, respiratory rate, and blood pressure. He told the doctors he tried divert by injecting a black widow spider (Thief) in her veins in a suspension of distilled water. Doctors suspected that the injected dose of black widow venom was probably much higher than would be obtained from a bite, and its effects may have been exacerbated by the patient’s allergic reaction to the proteins in the venom. After the patient was treated for several days in an intensive care unit, her symptoms resolved and she was discharged.
8. Nut allergy was triggered by ejaculate
A woman developed hives, swelling under the skin and difficulty breathing after having sex with her partner. While receiving treatment at a hospital, she reported that she had a known allergy to Brazil nuts. She said that her partner ate them a few hours before sex, but that he took a bath and washed his hands thoroughly before intercourse. When doctors performed a skin-prick allergy test using samples of the partner’s semen before and after he ate Brazil nuts, they found that allergy triggers could actually pass through the semen and trigger the woman’s allergy.
9. The rash has mysteriously migrated
A man’s red rash appeared to be “migrating” across his skin, doctors discovered. | Credit: The New England Journal of Medicine ©2022
Following cancer treatment, a man developed a red rash that started near his anus and then rapidly spread to his trunk and limbs. The rash, which looked like wavy lines all over the patient’s body, it seemed to migrate, the lines starting in one place and later moving across the skin. A stool test revealed Strongyloides stercoralisa parasite that can cause an infection called strongyloidosis in humans. These worms were migrating under the man’s skin, and the infection probably occurred because the patient’s immune system was turned off by the glucocorticoids used to treat his cancer.
10. Rare surgical interventions performed on the tooth in the eye
A rare autoimmune disorder has damaged a man’s cornea and significantly impaired his vision. To restore sight in one eye, doctors tried an osteo-odonto-keratoprosthesis or “eye tooth surgery.” The procedure involves removing a patient’s tooth and implanting it into the socket, where it serves as a platform for a clear plastic lens. The lens represents the injured cornea and allows light to enter the eye. The man’s successful procedure was the first of its kind in Canada.
11. “Muscle-boosting” injections cause a calcium spike
A man went to the hospital because he was weak and vomiting. There, tests revealed that his kidneys were failing and the calcium in his blood was too high. Physical exams and scans revealed abnormalities in the muscles of the arm and chest—namely, areas of superdense calcification. It turned out that the man had done it before received injections of oil-based, silicone-like substances to “enhance” the appearance of his muscles. In this case, the injections triggered a persistent foreign body reaction that resulted in extensive scarring and calcification of the muscle that leached calcium into the bloodstream.
12. The scientist catches the plague from the decaying bacteria
OTHER DILEMMA
— A woman kept tasting bleach — and doctors found a hidden cause in her blood
— Broken penis tattoo left man with permanent semi-erection
— Speed-eating a 7-pound burger sent a man to the ER unable to pass gas
A laboratory worker contracted an infection that, despite medical treatment, ended up being fatal. His doctors were informed that the patient had been working with a weakened strain of Yersinia washed aways, the bacterium that causes the plague. This weakened form of The germ was thought to be non-infectious, but the man nevertheless contracted it. Further tests showed the man had unusually high levels of iron in his blood. One way the plague bacteria was weakened was that its key iron-absorbing gene was removed – but the man’s blood, which was full of iron, would have allowed the germ to overcome this weakness and establish a deadly infection.
For more interesting medical cases, check us out Archives of the diagnostic dilemma.
This article is for informational purposes only and is not intended to provide medical advice.