The TWiPerati solve the case of the Man Who Sat in Feces, and discuss a study on how Dickson’s favorite parasite induces the formation of a collagen capsule.
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Case Study for TWiP 128
Daniel doesn’t expect anyone to get this. From Australia, 80 yo retired teacher from Atherton, northheast Australia, presents to clinic with generalized weakness, concern of chronic lyme or Q fever. Seen by neurologist, concern about motor neuron disease. 18 months of illness, insidious onset of limb (arms and legs) weakness. No issues with speaking, swallowing or breathing; no weight loss; no fever, sweat, chill. History of osteoarthritis, joint replacements; myocarditis; vertigo; allergic to pen and dox. Father, rhematoid arthritis, brother colon cancer. On a number of medications. Does extensive travel, when not traveling, is a volunteer carer in Australia (abandoned wildlife), over the past three years. Lives with husband. Marsupials, hand feeds puggles and juvenile spiny anteaters, has pet cockatoo. No history of polio, HIV negative. Neuro exam: diffuse non tender muscle with no rash. Normal upper and lower limb tone, strength is symmetrically reduced proximally. Reflexes good at knees, normal sensation to all modalities. Normal cranial nerve exam. Test results: has eosinophilia, elevated muscle enzymes, EMG shows myopathic changes, nerve conduction normal. Stop statin therapy, no change. This is a rare parasite.
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Music by Ronald Jenkees