Male 16 years old

This 16 year old youth has suddenly developed a bizarre and unusual belief that he has "no bone".  The thought disorder settles rapidly on Paill Spectrum type therapy and stays better.  These symptoms are generally described as psychosis.  Families become very distressed by odd unusual symptoms that are hard to understand..

1st Presentation: May 2005:

Lethargy, Sore shoulder and Malaise

On examination: Back to top

• Pulse rate 84 beats per minute, regular and normal
• BP 130/ 80 Sitting: normal
• Temp 37.5 degrees Celsius
• Pharyngitis +2 (bacterial type)
• Cough: mild
• Cervical Nodes felt, +2/4 in severity, bilateral
• Hands noted to be very sweaty

 Treatment:

Paill Spectrum compatible antibiotic : suitable also for throat infections.

Multivitamin

Case 7    Comment 1 

2^nd Presentation: August 2005 Back to top

• Aches and pains in the low thoracic spine, both shoulders, arms and forearms
• The patient complains that there is something wrong. He states that there is “No Bone”. This statement is stated repeatedly in spite of multiple reassurances to the contrary from mother and doctor.
• There are no symptoms of respiratory infection.
• The patient points to lots of areas of “no bone”.

Case 7    Comment 2

On examination:

• Slightly sweaty hands
• Pulse rate 84 beats per minute, regular and normal
• BP 150/ 70 sitting
• Parasternal chest tenderness in all quadrants
• Faint instability on balance testing
• (Romberg: standing with feet close together with both eyes closed).

 

Treatment: Back to top

• Serenace: 0.5 mg nocte
• Minocycline 50 mg: two daily
• Blood Investigations initiated

 

 Approximately one week later: third presentation:

• Making sense
• Answering questions
• Looks well, smiles and smiles appropriately on this occasion

 Case 7    Comment 3

 Investigations:

• GAM Total 15.17 (GAM1= 14.17)
• IgG 12.20 (RR 6.73-15.36)
• IgA 1.96 (RR 0.99-2.97)
• IgM 1.01 (RR 0.38-1.9)

 

• E&LFTs: No significant abnormalities quoted.
• Note serum uric acid 0.38 (RR 0.25-0.50)
• Creatinine 0.08 (RR 0.03-0.09)
• Cholesterol 5.5
  
  
• FBC: normal
  
  
•  Antigliaden IgG 0.79 (RR<1.00)
• Antigliaden IgA 0.28 (RR <1.00)
  
  
• Serum Zinc 13.1 (RR 12.0-28.0)
• Se B12 370 (RR >130 pM)
• RBC Folate: 542 nM =238 mcg/ml

 Case 7    Comment 4

Dyslexia test: Back to top

• Doctor Asks: 3279 4063 --Patient writes down in response: 3269
• Doctor Asks: 2184 7587 --Patient writes down in response: 21485
• Doctor Asks: 9264 3087---Patient writes down in response: 29
• Doctor Asks: 2197 7851 --Patient writes down in response: 292
• Doctor Asks: 4239 2186 --Patient writes down in response: 39

 Case 7    Comment 5

 Treatment

• Multivitamin
• Zinc 22 mg elemental daily:
• Wheat free diet suggested
• Serenace to cease in one week
• Continue antibiotics Minocycline

 Final Review: two month later: Back to top

• Has been off Serenace for seven weeks
• Moods are better, noted by mother and defacto
• Has been performing quite well at school for some time now, was having considerable problems previously
• The “no Bone” thought (? psychosis) is gone and has been gone for some time.
• There seems to be some symptomatic benefit from the wheat diet.

 Case 7    Comment 6

On examination

• Well
• Hands still slightly sweaty
• No chest tenderness
• Pulse and Blood pressure are norm: no change from previous visits.

 Case 7    Comment 7

Treatment: to continue:

• Multivitamins
• Zinc
• Wheat free diet
• Minocycline
• Plan for review in another three months esp. with review of memory and dyslexia type symptoms

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