“You really need to call your doctor,” the woman’s friend said, shocked at the sight of the figure who met her at the door. “You look awful.”
The woman, who was 50, had just been discharged from the hospital, but she didn’t feel any better than she did when she was admitted a week earlier. Indeed, she hadn’t felt well for nearly three months since returning from a visit to her family in Kenya. To her friend, the woman seemed a ghost of her former self. She had lost nearly 30 pounds — from a frame that was small to begin with. Her eyes and cheekbones found a new prominence in this thinner face. Her skin looked gray behind the usual deep brown color, and her lips were pallid.
Until recently, the woman considered herself healthy. She saw her longtime doctor every year or so for a checkup, but she had no medical problems and took no medications. She moved to the United States from Kenya in her late teens and periodically traveled back to see her family. Before the recent visit, she and her children were vaccinated against hepatitis A, typhoid and yellow fever; she made sure they took medicine to prevent malaria. They traveled all over the country and had a wonderful trip.
Coming back, though, had been brutal. The jet lag was terrible; she felt exhausted, then feverish. And she was constantly on the verge of throwing up. After a couple of weeks of this, she called her doctor, only to be told that she was out of town. Instead, she went to a clinic at a Walgreens. The young doctor there asked about travel and she mentioned her trip to Kenya. When she was a child, she had malaria; now she felt the same way, she told the doctor. I don’t treat malaria, he told her; you really need to see your doctor.
Because her doctor was away, she called her local hospital for a referral. The doctor she saw agreed that malaria was possible. Certain forms of the parasite were resistant to the drugs people take when they’re traveling. He started her on a three-day course of an antimalarial drug. But she only felt worse: She felt feverish and sweaty and so weak she could hardly move. She itched all over. Her heart pounded furiously. And she kept on vomiting. After a few days she couldn’t even get out of bed. She called the doctor again, and he promptly sent her to the emergency room.
Because she was so sick, she was admitted to the hospital. She was given medicine to stop the vomiting, but the cause of her symptoms remained mysterious. She had three blood smears examined in a lab and none showed any sign of malaria. When she was able to eat, she was sent home. The thinking among her doctors was that she had been sickened by the medication she was given to treat the presumed malaria. Now that the medication was out of her system, she should get better.
Once home, though, she started throwing up again. She toughed it out for a week before finally dragging herself back to the same community hospital. The doctors transferred her to Rush University Medical Center, a larger academic hospital. They’d be able to figure it out there, the doctors assured her.
The patient spent a week at Rush getting IV fluids, antibiotics and test after test. The infectious-disease doctor looked for other parasites, viruses and mosquito-borne infections endemic to the areas in Africa she visited. Nothing. A liver biopsy showed injury but no sign of what might have caused it. A work-up for autoimmune diseases led nowhere. Ditto a survey for cancer. Medications relieved her vomiting, and she was sent home again, this time to follow up with the infectious-disease specialist the next week.
A Familiar Face
At home, the patient went straight to bed. Her friend called. “Mommy’s still sick,” the patient’s daughter told the friend. Hearing that the patient couldn’t even get out of bed, the friend hurried over. And that was when she saw how very sick the patient was. The friend said the patient needed to call her regular doctor who had cared for her over the past 20 years. The friend picked up the phone and made an appointment for the next day.
Dr. Marie T. Brown was shocked by the appearance of her patient. She was hunched over the trash can, and the acrid smell of vomit filled the air. She was thin, and her left leg shook uncontrollably.
The patient filled in the doctor about the events of the past weeks. Moving the patient to the table, Brown started examining her, starting at her head and working her way down. She stopped when she got to the neck. The patient’s thyroid gland was much larger than normal. It wasn’t tender, but it was big. And the patient’s reflexes were wild. A little tap sent arms and legs flying. And her left leg seemed to have a life of its own: shaking, jerking, trembling.