Creating Waves of Awareness
A 48 years old non-hypertensive, non-diabetic gentleman, a Homoeopath by profession, was shifted at Shaad homoeopathic hospital from another center on 12/7/2010 for complaints of –
Fever was continuous to remittent, not associated with chill or rigor. History of mild headache with nausea was present. No history of bowel or bladder alteration, abdominal pain, cough, altered sensorium or bleeding from any natural orifices.
History of consumption of tablet Sulphadoxine + Pyrimethamine on the 3rd day of fever. After 24 hours of taking the tablet, he developed red, papular, tender, indurated lesions over both lower limbs up to mid thigh. He was hospitalized at the local hospital near-by and was diagnosed by a dermatologist, to have “Erythema Nodosum” of either drug Induced or infective etiology. An empirical course of antibiotics for Typhoid Fever was prescribed
The following was his investigatory profile (as mentioned in his Discharge card)
After 5 days of therapy, no response. Fever and rash persisted. Skin lesions more inflamed with cellulitis and pedal edema. Patient also started developing chest pain – dull, stitching type localized to the anterior past of chest. ECG – sinus tachycardia, rest within normal limits.
In addition to the above-mentioned drugs, the patient was started on (NSAID) Tablet Indomethacin and (Steroid) tablet Prednisolone 20 mg twice a day. Rash reduced but fever persisted; hence the patient opted for homoeopathy.
When patient came to us, he had
Fever – moderate grade, intermittent,
Skin rash - red, papular, tender, over both lower limbs up to mid thigh with swelling
Chest pain – left anterior chest, stitching type
Chilly, Appetite diminished. No specific desires / aversions. Thirst profuse for small quantities, Urine/ stool/ sweat and sleep – normal
State of Disposition – calm, answered logically and spontaneously. Memory of recent and past events was good. Liked company.
Conscious, co-operative, comfortable in lying and sitting posture
Weight -67 Kg
Febrile – 102 deg F
Pulse- regular, 100/min, good volume, non-collapsing, synchronous
BP – 130/84 mm Hg Right upper arm in sitting posture
Pallor +, No icterus, No cyanosis or clubbing
JVP- not raised. Edema feet ++
No stiffness of cervical muscles or neck rigidity
Ears / Nose / Throat – Normal
Spine / Joints - normal
Heart Sounds-pure, no gallop or murmur
Respiratory System- Air entry was equal on both sides. No adventitious sounds.
Abdomen – Soft, Non tender. Liver or Spleen - not palpable. Kidney’s not ballotable. Intestinal sounds heard in all 4 quadrants. Hernial orifices – normal
Skin - erythematous tender papules on bilateral lower extremities, from dorsum of feet to mid thigh with swelling.
Investigations on admission
All antibiotics, NSAIDs and Steroids were stopped and the case was repertorized with Kent’s Repertory
Drugs – Arsenic alb, Arsenic iod, Iodum, Kali arsenicum, Phosphorus, Sulphur, Sepia, Silica, Tuberculinum
12/7 SL 12 doses / 4 hourly
13/7 Fever 99 deg in eve x 1 hour warm water sponging
Pulse- regular, 78/min, BP-120/74 SL continue
Edema feet + but less
Heart Sounds-pure, Chest clear
Red papules on both lower limbs.
Non tender and reduced number
14/7 No fever. Eruptions less SL 3 times / day
15/7 No fever. Appetite normal SL 2 times / day
Eruptions only on the dorsum
No limb edema
16/7 Patient discharged. No Fever.
Eruptions only on the dorsum
No itching, redness or pain
ESR 11mm@1st hour
Discussion – There were several points against the drugs arrived after repertorization -
Now the following questions came to our mind
- Both – fever and skin eruptions are eliminations of the activated miasm. Should we treat them in the first place? As it is the patient is haemodynamically stable and no clear cut picture of any remedy is available. So why not wait and watch.
- Is the pathology that grave since all the investigations were within normal limits
- Do the rubrics need to be changed?
- Whether the Repertory needs to be changed?
- Should we ignore the mental state and only concentrate on the fever and eruptions?
- Should we take the rubric “Ailment from Bad effects of Drugs” i.e. drug reaction and administer Nux Vom or Sepia like drugs?
- Why not think of some lesser used remedies that have not come up in the reportorial chart?
- Is it wise to use a Nosode?
- Can we empirically give drugs like Pyrogen or Apis or Belladonna or Bufo and reduce the septic state?
In fine – Our patience with dealing with the patient did pay off, although the idea of a referred homoeopathic doctor being admitted in our hospital and being given only Placebo was quite alarming. Since we could not get a clear picture of any drug that came out in repertorization, we decided to wait and watch instead of engaging in over –zealous treatment. On follow-up, the patient reported complete disappearance of the nodules and no febrile episodes. The possibility of myocardiitis as a possible cause of chest pain was ruled out in the beginning. It was only a part of generalized myalgia which ultimately disappeared with disappearance of fever.
He joined his duties after a week of discharge from the hospital. Retrospectively, in our search for a nosological entity, only the pathologist and the radiologist had a D-day in this patient, otherwise, nature took care of the miasmatic disturbance on its own…..So sometimes Placebo works wonders too.
[Note – For reasons of Privacy, the name of the patient and the photograph of the lesions on admission and discharge are kept confidential since the patient has denied permission for publication]