During their many years of training, doctors around the world are instilled with the famous adage, “when you hear hoofbeats, think horses, not zebras” – meaning that most patient’s symptoms are caused by common conditions or diseases, and that providers shouldn’t consider the possibility of rare or exotic illnesses until the more mundane ones have been ruled out.
But of course, sometimes it really is a zebra. And thanks to case studies and the Internet, we lay people get to hear about the wackiest, weirdest, and most challenging medical occurrences faced by physicians. And because this year is almost over, we at IFLScience think it’s time to look back on the most unsettling medical stories of 2018.
In September, a New Jersey native named Fabrizio Stabile passed away from an infection with the “brain-eating amoeba” Naegleria fowleri. The team treating Mr Stabile – who presented to the hospital with a severe headache, fever, lack of motor control, and confusion – traced the amoeba back to a Waco, Texas, pool surfing park that the man had visited several days prior.
When Stabile was first admitted, his symptoms immediately pointed doctors toward bacterial meningitis, so they initiated an intensive regime of antibiotics and anti-inflammatories while performing a litany of tests to identify what microorganism was responsible. Four days later, a cerebrospinal fluid test came back positive for Naegleria fowleri, yet by then Stabile had sustained too much brain damage for doctors to attempt a specialized treatment. He died the next day.
Primary amebic meningoencephalitis (PAM), as this disease is called, is both highly fatal and incredibly rare. The Centers for Disease Control and Prevention (CDC) notes that only 143 cases (144 if you count Mr Stabile) have been documented in the United States. About 98 percent of these individuals passed away.
However, our frequent contact with the amoeba is usually unremarkable because it has no harmful effects when accidentally ingested. PAM can only arise when the organism is introduced into neural tissue through the nose and sinuses. This is why you should always hold your nose when swimming in fresh water and never, ever, EVER wash out your sinuses with unsterilized water.
One of several stories we reported on this year featuring a take-home message of ‘don’t eat uncooked sea creatures’ involved a 71-year-old man in South Korea. As reported in the New England Journal of Medicine, the anonymized individual came into contact with a highly pathogenic Gram-negative bacteria called Vibrio vulnificus when he consumed raw oysters. Just 12 hours later, he developed a fever and extreme, painful swelling and large blood-filled blisters, called hemorrhagic bullae, on his left hand.
He took himself to the hospital two days later, whereupon doctors quickly identified V. vulnificus inside the fluid in the bullae.
This patient’s infection likely took hold because he had type 2 diabetes, hypertension, and was being treated for advanced kidney disease – three conditions that significantly affect the integrity of blood vessels, particularly those in the extremities, and the body’s ability to clear pathogens from the bloodstream. The hemorrhagic lesions may have developed in his hand due to previous tissue damage to the vessels in that location.
Even with prompt and aggressive medical intervention – intravenous antibiotics and removal of dead tissue – V. vulnificus septicemia often progresses into a flesh-eating disease. After battling the infection for 24 days, the man’s forearm ultimately had to be amputated. He then recovered well.
A man with years of pulmonary health issues stemming from a severe congenital heart defect shocked his doctors when he “spontaneously expectorated” a blood massive clot that had formed in his bronchial tree, and as a result, resembled a perfect replica of 10 of his right lung’s airway branches.
Writing in The New England Journal of Medicine, the medical team explained that the patient was born with a bicuspid aortic valve, meaning that the valve that prevents backflow between his heart’s left ventricle and his aorta had only two prongs as opposed to the normal three.
To manage this condition, the 36-year-old had previously been implanted with a bioprosthetic valve and a pacemaker, but unfortunately, had progressed to severe heart failure when he presented to the authors at a hospital ICU. They attempted to treat him by implanting a ventricular assist device and administrating anticoagulant drugs, and the bloody bronchial sculpture was hacked up as a result.
Sadly, the patient passed away from complications of heart failure a week after surgery.
In a case that substantiates the advice we listed in the previous brain amoeba article, a woman from Washington died earlier this year after an undiagnosed battle with Balamuthia mandrillari.
The 69-year-old patient’s case was taken up by specialists when she was transported to the Swedish Medical Center in Seattle for an intense seizure and loss of cognitive ability. Using a CT scan, the team discovered a 1.5-centimeter (0.6-inch) lesion at the back of her skull. Believing it to be a brain tumor, the woman was quickly taken to surgery. But instead of a malignant growth, doctors were shocked to see a pocket of liquified brain tissue.
After pinpointing the causative microorganism, Dr Cobbs and his colleagues began trying to trace how and when their patient contracted the amoeba. They determined that she had contracted a sinus infection about one year prior, and had been advised to rinse out her sinuses. Yet instead of using distilled or sterilized water, she had apparently used tap water that been run through a drinking water filter. Soon after that, she developed a strange rash on her nose that never resolved.
The rash was likely the first sign that the dangerous amoeba had infiltrated nasal tissue, the event that allowed it easy access to her brain.
As occurs in about 90 percent of Balamuthia mandrillaris brain infections, the women died a few weeks later.
The next medical woe on our list, shared with the world through a BMJ Case Report in July, really is summed up perfectly with the title above, but we are going to give you more details anyway.
According to his treating physicians, a 53-year-old Australian man took himself to the ER after experiencing pain and lack of mobility in his right leg for the past day. He claimed to have had abdominal pain and swelling plus nausea for the past three days.
A rectal examination indicated that he had impacted stools, and an abdominal scan showed the man’s large intestine was distended to the point that it was pressing on his right common iliac artery – the artery that supplies blood to the right leg. And to make matters worse, the giant poop reservoir was impairing his kidneys and had therefore caused his blood to become dangerously acidic.
To remove the waste as quickly as possible, he underwent disimpaction surgery under general anesthesia, during which approximately two liters of feces were removed. He was also given gentle laxatives, and after four days, was able to leave the ICU. He regained the ability to walk after 13 days.
Doctors are unclear as to how the man became so constipated in the first place. Moral of this story? If you haven’t had a bowel movement in several days, please see a doctor.
A January article by the Hindustan Times reported the tragic death of a 32-year-old man who was pulled into an MRI machine while carrying a metallic object. Rajesh Maruti Maru was apparently visiting an elderly relative at the BYL Nair Charitable Hospital in Mumbai, India, when a staff member asked him to carry a cylinder of liquid oxygen into the MRI room.
Unbeknownst to the employee or Mr Maru, the machine had been switched on. So, when the canister entered the room, the machine’s powerful magnetic field immediately and forcefully sucked the object in, and the man was dragged along with it. Upon impact, the tank ruptured and Maru’s body was heavily injured. His death, which occurred a short while later, was attributed to oxygen toxicity syndrome – essentially, the cells in his central nervous system and lungs were irreversibly damaged by exposure to too much oxygen.
Due to aggressive safety precautions, events like this are incredibly rare, but they do happen.
According to AFP, the staff member and a doctor who was present were both arrested for negligence, and the local government awarded the man’s family 500,000 rupees ($7,855) in compensation.
Warning – this one is not for the faint of heart. As we reported back in February, a 26-year-old woman became the first documented human case of a cattle eyeworm (Thelazia gulosa) infection. All in all, Oregon native Abby Beckley and her optometrist plucked 14 of the tiny parasitic worms out of her left conjunctiva and eyelids, where they had been happily feasting off of the proteins in her tears and other eye secretions.
The first sign of the ordeal to come began when Beckley experienced left eye redness, irritation, and eyelid droopiness, on top of recurrent migraines, during a stint on a commercial fishing boat in Alaska.
After arriving back in port, she was finally able to look into a mirror, poke in her finger, and assess what was happening. She was not prepared for what she found but handled it admirably.
“I just pulled my hand back and stared at it in shock and was like, ‘oh my god, that’s a worm!’” Beckley told IFLScience. She said that she then went immediately from her flight home from Alaska to experts at the Oregon Health and Science University in Portland.
Under their advisement, the specimens she and her optometrist removed were sent off to the CDC for examination, which led to a world-first case report in The American Journal of Tropical Medicine and Hygiene.
If you’re craving more, please check out:
Execution In Alabama Goes Horribly Wrong – a tragic but politically important event.
This Might Just Be The Strangest Thing Doctors Have Ever Found Up Someone’s Ass – spoiler alert, it was 15 peeled, hard-boiled eggs!
Man Dies From Fatal Disease Transmitted By Eating Infected Squirrel Brains – a chilling case of a prion disease contracted through unusual means.