Chapter 475: Chapter 225: The Mysteriously Emaciated Patient, Good News Keeps Coming (Part 2)

No choice, after all, he is a law-abiding citizen.

"Jingsheng, there’s a pretty complex case here. I’ll send you the information. Please help with the consultation."

Lian Tao responded almost instantly.

"Send it over!"

Li Jingsheng had no confidence at all. Any case that even Lian Tao couldn’t handle was definitely not simple.

However, he had accumulated quite a bit of life value now, and his diagnostic skills had reached a certain level, so he wasn’t afraid to take on difficult cases.

Soon, the information was sent over.

The patient is an elderly person over 60 years old, with symptoms of weight loss and recurrent lower limb rashes, persisting for nearly four years. Recently, there was also fatigue, to the point of being unable to walk independently.

So, they came to the People’s Hospital for a consultation.

There had been treatments before, but only at local small hospitals, where it was always treated as eczema.

Recurrent flare-ups.

Many treatment methods were tried but yielded no good results.

As for a cure, that was out of the question.

The skin rash is truly tormenting, causing itching and psychological stress, creating significant distress for the patient.

Ordinary eczema wouldn’t cause such fatigue that the patient can’t even walk.

After examination, there was also an oral ulcer, just as recurrent as the lower limb rash, lasting for nearly four years.

Moreover, the tongue constantly felt painful, which had also lasted for four years.

It seemed that the patient’s illness wasn’t a simple digestive tract disease. It felt more like an issue with the immune system.

The patient had been eating normally for the past four years.

Since eating was normal, why would there still be continuous weight loss and the patient becomes emaciated?

Lian Tao had already prescribed clotrimazole for the patient to hold in their mouth to relieve tongue pain.

But this was merely treating the symptoms rather than the root cause.

Moreover, the patient’s symptoms weren’t limited to oral ulcers.

The medical records showed the patient was 175 cm tall, weighing 49 kg, clearly underweight.

Heart and lung examinations revealed no abnormalities.

The patient had mild tenderness about 3 cm below the right rib margin in the abdomen, with no shifting dullness in the abdomen.

There were scattered dark red patches on the anterior shin, and on the right shin, there was a flabby blister nearly 1 cm in diameter on the red patch.

Scattered blister ruptures could be seen, along with shallow erosions, some of which had scabbed over.

Some skin lesions even showed significant lichenification changes.

From these red patches, blisters, and shallow erosions on the legs, it bore a great resemblance to eczema and athlete’s foot.

Li Jingsheng had treated some patients with athlete’s foot, some with disease courses extending over six years, very stubborn.

Since athlete’s foot is a fungal infection, its greatest characteristic is difficulty in cure and easy recurrence.

It mainly attacks the skin, creating intense itching, cracking, blisters, and erosion. Applying regular dermatitis ointments can quickly take effect, but it relapses shortly after.

But this wasn’t the most bizarre.

After using an ointment repeatedly, the fungi become resistant, and the effectiveness significantly decreases with further use.

Many patients encountering such a situation would think it incurable.

This patient’s disease course lasted four years, and the lower limb symptoms were identical to those caused by fungal infection leading to athlete’s foot.

However, the patient also had oral ulcers and weight loss, seemingly ruling out the possibility of athlete’s foot.

Athlete’s foot commonly occurs on hands, feet, but it is very contagious, and if untreated for a long time, it may spread to other body parts.

For instance, the perineum, neck, etc.

Lian Tao had already conducted urinalysis and stool test for the patient, both normal.

Sudan staining was negative.

Hematochezia could be basically ruled out.

The patient’s food intake hadn’t decreased, and there were no obvious digestive tract symptoms like hematochezia, so why was there continuous weight loss?

Lian Tao initially suspected diabetes, but the urinalysis results were normal.

Then, to avoid misdiagnosis, a fasting blood sugar test was conducted for the patient.

The first result was 4.9 mmol/l.

Possibly worried about inaccurate results, or still suspecting a pancreatic issue, another test was done.

5.7 mmol/l.

Fasting blood sugar levels of 3.9-6.1 mmol/l are within the normal range.

This patient’s fasting blood sugar fluctuated a bit but stayed within the normal range.

By this diagnostic step, the focus should basically shift. You can’t hang on the pancreatic tree, can you?

But Lian Tao, just like Li Jingsheng, tends to get stuck on difficult cases, possessing an inexplicable confidence.

He had the patient measure blood sugar two hours after a meal, with the result being 8.3 mmol/l.

Still unwilling to give up, Lian Tao conducted an oral glucose tolerance test for the patient.

The 0-minute blood sugar level after ingestion was 5.2, 12.7 at half an hour, 18 after an hour, 15.6 after two hours, and 8.0 mmol/l after three hours.

The patient seemed to have mild diabetes.

But the patient’s complete blood count, urinalysis, and stool tests were basically normal, and fasting blood sugar was also normal.

Despite the glucose tolerance test fitting the diabetes curve, it was hard to determine the severity of the patient’s diabetes.

Moreover, the patient had never experienced ketosis or acidosis.

This bizarre condition is what makes Director Lian Tao, a chief physician in gastroenterology, stumped.

Further examinations showed a liver check, with the patient reporting never having hepatitis, but having had a hepatic hemangioma as per self-report.

Lian Tao tested the patient’s liver function, which was normal.

Also checked renal function, still normal.

And the patient’s temperature was also normal.

Eating and drinking were fine, food intake hadn’t decreased, and the basic triad of tests was normal, along with normal liver and renal function. So where did all the energy go?