Each week, Live Science features interesting case reports from the medical literature, exploring unusual symptoms, rarely seen diagnoses, and ready-to-use treatments. This Diagnostic Dilemma series describes how doctors work to finally discover the cause of a patient’s illness. In complex cases, this diagnostic process can be very difficult. One reason doctors share case reports is to help other medical professionals who may be facing the same problem.
Here are 12 of last year’s most interesting diagnostic dilemmas. (If you are uncomfortable with descriptions of medical symptoms or procedures, please read with caution.)
1. After the surgery, the boy spoke a foreign language.
A Dutch teenager underwent knee surgery to treat a soccer injury, but when he woke up from anesthesia he could only speak English. It was a language he had previously only spoken in language classes at school. He continued to claim he was in the United States, did not recognize his parents, and could not speak or understand his native language, Dutch. Tests revealed no neurological abnormalities, but doctors did not start any specific treatment to address the speech problems. Within 18 hours after the surgery, the boy could understand some Dutch, but could not speak it without difficulty. But suddenly he was able to understand and speak normally. Doctors described the incident as a strange case of “foreign language syndrome.”
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2. Women with no vaginal openings get pregnant through oral sex.
A teenage girl went to the hospital complaining of abdominal pain, and tests quickly revealed that she was nine months pregnant and in labor. When the doctor examined the patient’s reproductive tract, he found that she had no vaginal opening. This is a rare condition called distal vaginal atresia. As a result, the medical team had to deliver the baby, a healthy 6.2 pound (2.8 kilogram) boy, by Caesarean section. The teenager had also been to the same hospital about nine months earlier, when her ex stabbed her after catching her having a blow job with her new boyfriend. Doctors theorized that the wound she sustained during the sting likely allowed sperm to escape from her digestive tract and reach her reproductive tract, making pregnancy unlikely.
3. Man bitten by giant fish
The man was injured while fishing and was taken to hospital by boat and helicopter. He had caught a white marlin (Marlina alvida), a large fish with a long, pointed “beak,” and as he leaned over the edge of the boat to remove the hook from the fish, the fish jumped up and hit him. At the hospital, doctors found pieces of a fish beak stuck in the man’s throat, spinal canal and base of his skull. With emergency surgery and antibiotics to prevent infection, the man survived the encounter without any long-term symptoms.
4. Joint damage caused by acupuncture
A woman with knee osteoarthritis started receiving regular acupuncture treatments because painkillers made her stomach pain worse. But then my knee started hurting so badly that I went to the hospital for tests. X-rays revealed thickening of bone tissue and formation of spurs in the area of her joints and tibia. In addition, hundreds of small spots were seen around both knee joints. It turns out that a female acupuncturist intentionally left a golden thread on the inside of her knee as part of her treatment. In other cases, these threads can cause cysts and tissue damage as they move through the body.
5. A man experiences a rare meat allergy.
A Michigan man went to the emergency room complaining of swollen eyelids and an itchy rash, and said he had also been experiencing cramps, nausea, abdominal pain and vomiting for several days. Doctors examined the patient and found signs of anaphylaxis, a severe allergic reaction, which progressed rapidly and led to a state of shock. The medical team was able to stabilize the patient’s condition, but after a few days, his condition worsened again. At that point, doctors noticed a pattern. The symptoms appeared when the man ate red meat. An allergy to meat, a condition called alpha-gal syndrome, can be caused by the bite of certain types of mites. Doctors concluded that the man was an avid deer hunter and had likely encountered either an adult tick or a larval tick while hunting.
6. The woman had XY chromosomes in her blood.
A woman underwent chromosome testing after a miscarriage to see if there was a genetic reason underlying the miscarriage. This test revealed that, at least in the woman’s blood, her chromosomal profile (or karyotype) was 46,XY (the typical karyotype for men). Further testing revealed that the karyotype of her entire remaining tissue was 46,XX, a typical chromosomal profile for women. Because this woman had a fraternal twin, doctors concluded that in this case of “chimerism,” the XY chromosomes likely came from a sibling in the womb, but were somehow assimilated only into her blood cells. Doctors suspected that “the veins and arteries of both children became entwined within the umbilical cord at some point.” The woman had no obvious symptoms from having these chromosomes in her blood and went on to become pregnant and gave birth to a boy.
7. Woman injects herself with black widow spider venom
A woman presents to the emergency department complaining of a headache, severe cramps, muscle pain, and increased pulse, breathing rate, and blood pressure. She told doctors that she tried to get high by grinding up a black widow spider (Latrodectus) in a suspension of distilled water and injecting it into her veins. Doctors believed that the amount of black widow spider venom injected was likely much higher than the amount ingested in one bite, and that the patient’s allergic reaction to proteins in the venom may have exacerbated the effects. The patient was treated in intensive care for several days before his symptoms subsided and he was discharged.
8. Nut allergies were caused by ejaculation.
A woman developed hives after having sex with her partner, causing swelling under the skin and difficulty breathing. While receiving treatment at the hospital, she reported that she had an allergy to Brazil nuts. She said her partner ate them several hours before sex, but she took a bath and washed her hands thoroughly before sex. When doctors performed a skin prick allergy test using a partner’s semen sample before and after the partner ate the Brazil nuts, they found that the allergy-causing substances could actually pass through the semen and cause the woman’s allergies.
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9. The rash has mysteriously migrated.
After cancer treatment, a man developed a red rash that started near his anus and quickly spread to his trunk and extremities. The rash looked like wavy lines all over the patient’s body, and the lines seemed to start in one place and later move and move across the skin. A stool test revealed strongyloidosis, a parasite that can cause an infection called strongyloidiasis in humans. These parasites were traveling under the man’s skin, and the infection likely occurred because the patient’s immune system was inhibited by glucocorticoids used to treat cancer.
10. Rare eye tooth surgery performed
A rare autoimmune disease damaged a man’s corneas and severely hampered his vision. To restore vision in one eye, doctors tried a bone-tooth-keratoprosthesis, or “surgery on the tooth in the eye.” In this procedure, one of the patient’s teeth is removed and implanted into the eye socket to serve as a platform for a clear plastic lens. The lens replaces the damaged cornea and allows light to enter the eye. It was the first successful surgery on a man in Canada.
11. “Muscle plumping” injections cause calcium spikes
The man went to the hospital after experiencing weakness and vomiting. Tests there revealed that his kidneys were failing and his blood calcium was too high. A physical examination and scan revealed abnormalities in the muscles of the upper arm and chest: areas of hyperdense calcification. It turned out that the man had previously received injections of an oil-based substance, such as silicone, to “plump up” his muscles. In this case, the injection caused a sustained foreign body reaction, causing extensive scarring and calcification in the muscle and leaching calcium into the bloodstream.
12. Scientists transmit plague from infected bacteria
A lab worker contracted an infection that ultimately led to his death despite treatment. His doctors were informed that the patient was dealing with a weakened strain of Yersinia pestis, the bacterium that causes plague. Although a weakened form of the pathogen was thought to be non-infectious, the man was still infected. Further tests revealed that the man had abnormally high iron levels in his blood. One reason for the weakening of the plague bacteria was that a key gene for absorbing iron was removed. But the man’s iron-packed blood may have allowed the plague bacteria to overcome this weakness and cause a deadly infection.
For more interesting medical cases, check out our Diagnostic Dilemma archives.
This article is for informational purposes only and does not provide medical advice.
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