Lupus of Larynx: A Case of SLE?
NATIONAL JOURNAL OF HOMOEOPATHY 2004 May / Jun VOL VI NO 3.
Dr Mirza Anwar Baig
'Lach / Thuja / Nit-Ac / Virionum
Introduction
SLE, Systemic Lupus Erythematosus, is a multi-system disease characterized
by recurrent erythematous eruptions, occurring mainly in women. Inflammatory
lesions are seen in the kidneys, joints, skin, heart and other organs.
Diagnostic hallmarks are immunology and histology. Initial symptoms along with
erythematous rashes are fatigue and melancholy. Untreated cases have poor
prognosis. 75% patients may survive five years, 25% may live longer or die
during acute stages due to misdiagnosis. They develop early complications
because of their compromised immune system. Majority of researchers agree to
include SLE in the category of auto immune disorders.
The Case
Mr MI, 35 yr, was brought to us on 19.1.04 in a critical condition. He was
well built and fair with multiple pox like scars over his face and nose. His
jaws were locked and lips eroded with ulcers extending inside mouth and throat.
Tongue was coated and mouth filled with saliva with a cadaveric odour. He was
very weak, sad and frightened with dyspnoea.
When opened his mouth to speak, his hoarsewas voice, his teeth got exposed and saliva dripped like a wounded wolf. He said "I can’t swallow my saliva, can’t eat, can only take milk in sips with difficulty. Food and water choking." We observed his neck veins got engorged when describing his sufferings, showing severe exertion to talk.
He was carrying a big file with a battery of tests, final option was surgery. Tata Memorial Hospital, Mumbai, advised immediate removal of Larynx, as he would die any time due to suffocation. He refused removal of sound box and preferred alternative medicine.
Case taking
Patient was accompanied by his brother. He said: "Doctor, I have come
here from another state, came to get treatment at Jaslok and lost all my funds.
I know I won’t survive. Someone has directed me to you, so please give me some
medicine so I can reach my hometown safely. If I die there I won’t mind,
everybody has to die one day."
Patient was a businessman. Since the past few months, he was suffering from recurrent pustules, mostly on face, dense around nose. At his hometown in UP, he consulted many dermatologists but no respite, despite steroid treatment. On one occasion, he developed severe cough and cold along with these rashes and then pneumonia, for which he underwent long hospitalization. Thereafter he started getting cough and cold with mouth ulcers and rashes of such intensity, that he required frequent hospitalization.
A discharge note from St Stephen’s Hospital, Delhi, dated 16.8.03, stated:
Oral candidiasis. Patient has taken several courses of antibiotics.
The ENT hospital Maujpur, Delhi, dated 30.8.03, diagnosed it as oropharyngitis.
Another ENT hospital, Vats centre, Delhi, dated 20.11.03, diagnosed autoimmune
disease. Also they evaluated that Typhoid and Para-Typhoid antibodies were the
cause of vocal cord affection.
At this stage, an ENT surgeon warned "Avoid Broad Spectrum Antibiotics," and referred him for dental check up.
On 29.12.03: Patient landed in Jaslok Hospital, Mumbai, the
Mecca of Medicinie.
A Battery of Tests were performed:
VDRL Negative. HIV Negative. ESR 78 mm
SGPT 92 UI/L.
Treated as antifungal and sent for biopsy to TN Medical College and BYL Nair
Hospital, Mumbai.
2.1.2004 Histopathology revealed. Discoid Lupus Erythematosus. By now patient
developed more respiratory distress and fever was treated as malaria and
developed further complications, then shifted to the Institute of Immuno
Haematology, KEM Hospital.
9.1.04: Patient’s Antiglobulin Test; ANF and Anti-dS DNA were negative.
From KEM Hospital he had been shifted to Tata Memorial Hospital, from where he
came to us.
Discussion
I asked my group of students: What could be his remedy? Arsenic said
some. Others prompted Carcinosin! Symptoms noted were cadeveric smell,
choking, can’t even swallow his saliva. Prostration and anxiety.
Repertorisation revealed the remedy as Acid-nitric.
So shall we give him Acid-nitric.? "Yes", said most. But what if he dies! Silence. "Yes indeed he has clinical symptoms of Acid-nitric, but is he frightened for death? Or looks composed?" (Patient was relaxed and listening to us). I added further: Fear of death in Acid-nitric is very marked. On the contrary our patient looks composed. His fear is not for death, is rather anxiety that he may not reach home. While we were discussing his case, he was coolly watching us, no expression of anxiety with fear. (Perhaps because of my coolness, he was also relaxed. I had already decided Thuja as his remedy). I told them: Acid-nitric like Ars, Phos and Lachesis is known to cause euthanasia, this would be better mercy killing than cortisone. Shall we give him? Some laughed, some still doubted my analysis and some were looking into their repertories.
See into your repertory, fear of death; Acid-nitric scores 3 marks (Kent’s Repertory, Page 44), while Thuja has no marks. But if you see anxiety with fear (Page 6), Nitric-acid scores 2 marks and Thuja 1 mark. Thuja has no fear of death but has anxiety about death. If we analyse this way, patient knows he is having cancer but he is not frightened. On the contrary, he is asking for help to reach his hometown.
In terms of rubric you can see this; Delusion, sees death. (Page 24). The rubric is: time has come to die. Thuja and Lach are there, not Acid-nitric. He has decided to go home and no surgery even if he dies. He is sure about death but also sure about rejecting surgery. Is not this a fixed idea of Thuja? He wants to go home not because he is home sick, but because he knows he will die, so is frightened and anxious but again not that much so as to catch you and beg like Arsenic, ‘save me Doctor’.
Or is he like an ‘Opium’ who wants a little relief, so can reach home?
Certainly not Opium as Opium’s fear is very marked and they grope whom to trust! They remain confused with their half faith and run from one doctor to other. Here he looks relaxed and has come with full faith. His first specific serological report, carried out at Delhi indicates Typhoid and Paratyphoid antibodies as the cause. His biopsy carried out at Mumbai confirmed Lupus. But the special reference Tests, ANF and Anti-dS DNA are negative! Are these overruling the diagnosis, Lupus?
For an allopath or a cancer specialist this would be simple: that so and so case has no SLE, but what about a homoeopath, what have we understood homoeopathically from these tests?
