The 57-year-old looked up the long staircase leading to his rooms in the rectory, the residence he shared with three other priests. He grabbed the railing on either side of the stairs and forced his foot up to the first step. He slowly climbed the two flights of stairs to his room. His trip to Boston after a conference in Asunción, Paraguay, had been difficult. It was an overnight trip, but he hadn’t been able to sleep at all. Now all he wanted to do was take off his Roman collar and lie down.
When he finally got to his room, he looked at himself in the bathroom mirror. Her face was bright red and shiny with sweat. The red continued down her chest to her belly. Her whole body hurt. He gratefully crawled under her blankets. What he really needed was a good night’s sleep, he told himself. But as sleep continued to elude him, he suddenly felt cold. He trembled uncontrollably. The chills confirmed what he already suspected: he was sick. And that worried him.
Six years earlier he felt this bad after a flight. She went to the hospital and was diagnosed with non-Hodgkin lymphoma. The treatment had been brutal. The seven months of chemotherapy killed the cancer but also destroyed his body’s ability to make blood on its own. He was rescued with stem cells (the cells that create the blood he needed) taken from his own body before starting treatment. Since then he had not suffered from the disease, but he knew that a recurrence was possible. It was a low-level anxiety that he dealt with with each subsequent symptom. Before cancer, he might have just endured it. Not now.
He called Dr. Peter Zuromskis, his longtime primary care doctor. She hated bothering him on a Saturday, but he thought this was important enough to warrant the call. “Go to the emergency room,” the doctor told him after learning about his trip and his fever, rash, and weakness all over his body. “You need to be seen.”
Problems carrying your suitcase
One of his housemates took him to the emergency department at Beth Israel Deaconess Medical Center. It was already dark outside when he passed through the busy emergency room and entered a hospital room. He repeated his story half a dozen times to various doctors, nurses and trainees as they poked, prodded, stuck and took pictures for hours. The priest was grateful for the tranquility of the small room where he could finally rest.
Dr. Martin Kaminski was the night shift hospitalist. He introduced himself and asked the patient to tell him his story, listening as the man described his journey, his weakness, his rash, his fever. His temperature was 102 when he arrived at the hospital, but he had brought it down with acetaminophen and intravenous fluids. When the patient reached the end, Kaminski had a few more questions. Had he used insect repellent while he was in South America? No, the priest remembered. A fellow priest gave him a bracelet that he was supposed to keep mosquitoes away. He hadn’t felt any sting while he was there. He only drank bottled water, he added. Did he leave the city or hike through wooded areas? Had he been in contact with any domestic or farm animals? No, he was too busy to leave the hotel where the conference was held.
Kaminski asked if he had any pain in his body. He did. And before, he felt pain in his right hand and a little weak. He had trouble carrying his suitcase. On the way home, his neck felt strangely weak, as if his head had suddenly become much heavier. His neck still felt sore and stiff. The doctor asked him if he could rest his chin on his chest. A stiff neck could suggest meningitis. But the patient showed that he could. He was worried, the priest told Kaminski. He had felt so sick only once in his life, and that time he was diagnosed with lymphoma. Could he have returned? In the ED, the hematology-oncology team recommended a CT scan of his chest, abdomen, and pelvis, but they had not yet had one. Kaminsky told the anxious man that he thought an infection was much more likely than cancer. But they would know more after the CT scan.
A bite on the ankle?
While examining the priest, Kaminski noticed that he had a rash on his back, arms and chest. It looked like a sunburn, and the red skin paled to almost white when Kaminsky pressed his finger on the bright-colored skin of his chest, indicating that it was some kind of inflammation in the skin rather than blood leaking from the vessels. under it. . He had a red, painful nodule on his ankle, possibly a bite. Otherwise, his examination was unremarkable. The lymph nodes in her neck, groin, and under her arms were not enlarged. If she had lymphoma, it wasn’t obvious. Infection remained the most likely cause of his misery.
According to the Centers for Disease Control and Prevention, the doctor told the priest, there was an outbreak of chikungunya fever (a viral infection transmitted by mosquitoes) in Paraguay. And most of the cases had been reported where he had been, in Asunción. The disease is usually not fatal, but can cause arthritis that can last months or even years after the infection clears.
Of course, there were other possibilities, Kaminski added. It could be dengue, another viral disease transmitted by the same mosquito. Dengue can cause high fevers and body aches so severe that the illness is called bone-breaking fever. And it can be deadly. While patients infected the first time are often miserable, those unlucky enough to contract it a second time are at risk of developing a hemorrhagic version of the infection. Each infection is common throughout South America. Each one is a virus, transmitted by the same mosquito. Chikungunya is famous for its abrupt onset and short incubation period, so it was first on his list. Another possibility was that it was something he contracted before leaving his home in the northeast. Maybe a tick-borne disease, like Lyme or anaplasmosis. They should have the answer within the week.
Persistent pain and fatigue
The patient felt better the next day and was eager to return home. The fever and weakness were gone and the rash was fading. Only the pain remained. His doctors still weren’t sure what he had. The only thing that was known at the time was that it was not a recurrence of his lymphoma. The CT scan showed a pair of enlarged lymph nodes in his chest, but the radiologist thought they were more consistent with an infection. Scans of his abdomen and pelvis, where his original cancer had been located, seemed fine.
In the days after the priest’s release, Kaminski watched the test results come in. The chikungunya test was negative. So was the dengue test. It wasn’t any of the other illnesses he and the infectious disease doctors had looked for.
As for the patient, although the fever had disappeared when he left the hospital, fatigue and body aches persisted. His head felt cloudy; Even reading was difficult. Over the next few weeks he felt better, but not well. He went to see Zuromskis and described his persistent discomfort. What else could this be? Zuromskis smiled. He was sure it was chikungunya. But the test was negative, the patient reminded him. “That test then came back negative,” he responded. If he repeated the test now, the doctor was sure it would be positive.
These first results showed the priest’s immune response to each of the infections they were looking for. If he had ever been exposed to that virus before, the test looking for the antibody would immediately come back positive; the template to combat that bug would have already been created by the immune system and stored from it. If, however, it were a first infection, the body would take days to prepare and create personalized antibodies, adapted to this specific invader. It might have been negative while he was in the hospital, but Zuromskis was sure it wouldn’t be negative now. He sent tests to detect the suspected viruses. The results came a few days later. Only one was positive. Very positive. He had chikungunya fever.
The trip to Paraguay was eight months ago. Full recovery was slow. The stiffness and joint pain lasted for months. Only recently has she been able to climb the stairs with his former vigor and speed. And yet, despite the infection and his history of cancer, he is, he tells me, a healthy man.
Lisa Sanders, MD, is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Perplexing Medical Mysteries.” If you have a solved case to share, please write to her at Lisa.Sandersmdnyt@gmail.com.