Patient Overview: The patient is a 78 year old female . On December 17, 2019 she developed rashes on both groins with large red patches, exudates, and itching. There was no pain, no other skin lesions, no joint pain, and no discomfort in the limbs. She went to the 1st Affiliated Hospital of Sun Yatsen University. After examination, she was diagnosed with secondary dermatitis (fungus + bacteria). She received anti-fungal, antibacterial and symptomatic treatments and her condition improved. On January 7th, she developed coughing, chest congestion and asthma. She went to the hospital where a CT Scan was performed. The CT revealed interstitial inflammation of both lungs. Despite anti infective treatment (the specific medication is unknown), her condition worsened. On January 14th, family members of the patients noted that the bilateral groin rash had expanded the color was deeper, and there were skin lesions. The patient complained of severe pain. She denied new rashes on her limbs. She also denied canker sores joint pain, fever and chills. On January 17th her cough became worse, she became short of breath, had a low grade fever. Since the patient has multiple underlying diseases and had multiple presenting problems, she was admitted to the hospital for control of her lung infection and management of her conditions.

 

Preliminary diagnosis: 1.Pneumonia 2. N on Hodgkin’s lymphoma of the central nervous system (diffuse large B cells) with relapse after chemotherapy 3. bilateral groin secondary dermatitis, 4. Hypertension grade High risk group 5. Subcortical arteriosclerotic encephalopathy 6. Sequelae of cerebral infarction (bilateral frontal parietal temporal lobe, radiation crown) 7. Brain atrophy 8. Internal carotid artery S mall aneurysm of the internal carotid artery 9. Sinusitis 10. Hyperostosis 11.Esophageal hiatal hernia 12. Nodular goiter.

 

Treatment Excerpts:

2/14/2020, in the morning, the blood pressure of the patient was 139/83 mmHg, the heart rate was 67 beats/min, the body temperature was 36.7°C, the finger oxygen was 99%. There was no cough, her condition was good, and the fatigue was significantly reduced. The patient’s condition was improving, so tigecycline was discontinued and the Chinese medicine continued to be taken. After each dose, she occasionally spit foam 2 to 3 times, the cough was significantly reduced, the bowel movements were reduced to twice, the color was dark, the consistency was thin, and the volume was increased. Her spirits improved significantly, her the limb muscle strength was improved, as was her willingness to move independently. 15

16/2/2020 , she continued to take the Chinese medicine twice a day with no more foaming at her mouth . She did slightly sweat after taking the medicine, and experienced bowel movements 1 to 2 times . Her stools were black and normal in nature and quantity. Her mental, mobility, and cognitive functions improved significantly.

17/2/2020, Blood tests : C reactive protein 14.29mg/L, WBC 8.75×10 9 L, NEUT 3.83×10 9 /L, Hb L, PLT 348×10 9 L; CRP 14.29mg/ L; Blood biochemistry was basically normal. The patient’s cough and sputum improved significantly compared with previous, and she was discharged. There was no chest tightness, shortness of breath, or other discomforts when discharged.

Physical examination: 20 breaths/min, blood pressure 133/75mmHg, heart rate 76 beats/min, occasional early beats, finger oxygen 99%. There were no abnormal lung sounds. There was no ulceration of the skin, and no edema in the lower limbs.

 

Upon discharge, she was switched to levofloxacin tablets 500mg QD to continue treating the pneumonia and she was instructed to continue taking the traditional Chinese medicine.