You be the doctor

The Deceptive Case of the ‘Sheep in Wolf’s Clothing’

A normally healthy African American woman in her mid-30s suddenly began experiencing high fevers, weight loss, severe headaches, and night sweats to the point that her nightgown was soaked. Perhaps most alarming, knots had begun to emerge on her neck. Her doctor recommended an ultrasound that revealed more than 13 swollen lymph nodes, most on the left side of her neck, with a large nodule in her thyroid gland. More testing showed that her thyroid activity was normal; a fine needle biopsy of the lymph nodes and thyroid mass was inconclusive. She was referred to Clyde Partin, director of Emory’s new Special Diagnostic Services Clinic. Blood work showed a high sedimentation rate, which suggests significant systemic inflammation and can indicate abnormal conditions such as infection, an autoimmune disease, or even cancer.

One possibility was lupus, but she tested negative for lupus antibodies. Even though she had no pets, she was tested for cat scratch fever, which has many of the same symptoms (especially the swollen lymph nodes) but that titer also was negative. “I was concerned about a lymphoma,” says Partin, who arranged to have one of her lymph nodes removed.

In this case, the pathologist helped solve the mystery. All the special markers matched a rare syndrome called Kikuchi-Fujimoto disease, a self-limiting disorder that typically affects the cervical lymph nodes and is often mistaken for something far more serious (one medical journal called it a “sheep in wolf’s clothing.”) Most episodes of Kikuchi clear up in three months with no medication, which is exactly what happened to Partin’s patient. n

Therapy for PTSD: Short doses— as little as five sessions—of virtual reality exposure therapy reduces posttraumatic stress disorder symptoms in veterans, found researchers led by Professor of Psychiatry and Behavioral Sciences Barbara Rothbaum, in a clinical trial involving Iraq and Afghanistan combat veterans with PTSD. The results were especially significant when the therapy was combined with the antibiotic d-cycloserine. (Interestingly, alprazolam, commonly known as Xanax, impaired recovery from symptoms when administered with the therapy). Virtual reality exposure therapy involves being immersed for 30 to 45 minutes in computer-simulated environments similar to those vets experienced in combat with the sights, sounds, and smells of battle, such as explosions, helicopters flying overhead, and smoke. n

Autism and tummy troubles: Children with autism are more than four times as likely to experience general gastrointestinal discomfort as their peers, three times as likely to have constipation and diarrhea, and twice as likely to have abdominal pain, found researchers from Emory School of Medicine, the Marcus Autism Center, and Children’s Healthcare of Atlanta, in a study published in the journal Pediatrics. “Our findings corroborate a history of anecdotal reports and case studies suggesting increased risk of GI concerns in autism,” says coauthor William Sharp, director of the Pediatric Feeding Disorders Program at Marcus Autism Center and assistant professor of pediatrics. In many cases, say the researchers, the children may not be able to communicate these problems or pains directly, and the only indication might be an emergence or escalation of problem behaviors like self-injury, aggression, or irritability. n