CHAPTER 339: DARING GUESS

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Liu Banxia had no solutions for the current situation either. They had to wait for the CT scan results to see how things stood, but the young man’s condition was indeed somewhat dangerous.

After a few minutes, Xu Hui’s phone received a text message. After glancing at it, he quickly began working on his computer.

"It seems there’s lung infiltration already. Is it likely that pneumonia caused respiratory distress, fever, and this lung infiltration?" Liu Banxia commented after reviewing the information.

"First, let’s give him some Levofloxacin to see if there’s any improvement. Then we can ponder what might have caused the necrosis in his finger."

Xu Hui nodded. "That’s the only option for now, as we still can’t determine whether the necrosis was caused by a lung issue or if the lung issue was caused by the necrosis."

"But there’s nothing striking about the blood test results. Ordinarily, with this level of fever, the white blood cell count should be soaring."

Zhang’s condition was very puzzling. For now, they could only treat the issues they could detect; those that remained undetected would require further investigation.

"Have the results come in? Any leads?" Shi Lei asked, stepping out of the treatment room.

"Not yet. The CT showed lung infiltration. We’re presuming it’s caused by pneumonia and plan to administer Levofloxacin once the patient is back," Xu Hui said.

"What about you?" Shi Lei then looked at Liu Banxia.

"We can only proceed like this for now. However, what Brother Xu and I are most concerned about is that little finger. I’ll examine the actual situation later to see how fast it’s progressing," Liu Banxia said.

Shi Lei nodded. "Let’s begin with Levofloxacin. Has the patient’s family arrived yet?"

"Not yet. The patient is a migrant worker here in Binhai City," Xu Hui responded.

Liu Banxia frowned slightly. If the patient’s family were present, perhaps they could glean more information by talking to them.

Often, the patient themselves are unaware of any abnormal situation, while family members might pick up on changes from their usual condition.

When the patient was brought back, Liu Banxia was taken aback by the appearance of Zhang’s little finger; it had grown several shades darker, and the signs of necrosis had extended significantly.

If it continued to progress at this rate, this finger might be completely necrotic within ten hours.

"Look at his ring finger! Is the tip of it also turning black?" Liu Banxia shouted after observing closely.

At his shout, Shi Lei and Xu Hui hurried over. However, because of the oil stains on Zhang’s fingers, they had difficulty telling for sure.

"I examined his freshly washed hand, and it definitely was not this color at that time," Liu Banxia said.

"The way this necrosis is spreading suggests an infection. If there are no external factors, then it must be an internal one. The blood, perhaps?"

Shi Lei’s brow furrowed. "We considered that, but we found no anomalies in the blood tests."

"This spreading necrosis is a new symptom we’ve just observed. We’ve taken a blood sample from his little finger for a culture, but that will take too long. Keep thinking; see if there are other possibilities."

"What about fungal pneumonia?" Liu Banxia suggested. "Could it be that these fungi traveled through the bloodstream to the fingertips, lodged there, and caused the necrosis?"

"That’s a possibility," Shi Lei said. "Get a nasopharyngeal swab test. Monitor the patient’s vital signs constantly. You, as the patient’s family member, don’t seem to have much else to do, so you can keep an eye on him personally."

"Repeat the bedside chest X-ray in forty minutes. If the lung inflammation hasn’t subsided, we’ll try amphotericin B, starting with 0.25mg per kilogram of body weight. I have a surgery to attend to. Xu Hui, you stay on top of this. Feel free to consider this family member’s opinions."

Liu Banxia felt rather helpless, but this was the only viable approach for now.

If it was indeed fungal pneumonia, Amphotericin B would be the indicated treatment. However, this drug carried risks; even within the prescribed safe dosage, it could cause kidney damage.

In his heart, he felt certain this wasn’t ordinary pneumonia, and Levofloxacin would likely be useless. However, he was currently in the role of a patient’s relative.

When he was a doctor, he couldn’t unduly influence the patient’s family. Now, posing as a family member, he couldn’t unduly influence the doctors. Otherwise, if something went wrong, he himself would face no repercussions, but others would suffer the consequences.

Presently, there were two suspected conditions: disseminated intravascular coagulation and fungal pneumonia.

Disseminated intravascular coagulation wasn’t an independent condition but a complication arising from other conditions. The usual causes included bleeding, thrombosis, shock, or organ damage, none of which aligned with the patient’s initial examination findings.

Liu Banxia had suspected thrombosis earlier. However, the patient’s normal blood circulation, combined with the fact that the necrosis was now spreading, allowed him to rule out thrombosis completely. This led him back to the possibility of an infection.

Monitoring the patient didn’t mean staring at him non-stop. Whether Levofloxacin was working or not wouldn’t be visually discernible; it simply needed time.

Liu Banxia glanced around and then walked over to Zhou Li and Qiaoqiao.

"How is it, is he cured?" Qiaoqiao asked.

"It’s not that easy. We still haven’t figured out the exact condition. Moreover, the tip of his ring finger has also started to discolor, showing early signs of necrosis," Liu Banxia said.

"Oh! Can he still be saved? They’re not going to have to chop off both fingers, are they?" Qiaoqiao asked in surprise.

"We’ll see if we can intervene in time," Liu Banxia said. "Amputation would only be necessary if the entire finger becomes completely necrotic."

"This is a bit different from a flesh-eating bacteria infection, which progresses very quickly. This one is progressing slowly. Right now, our main suspicion is an issue with the inflammation in his lungs. Does that sound a bit confusing?"

"No, I actually find it quite interesting," Qiaoqiao said, shaking her head.

"Are you two done yet?" Zhou Li said helplessly. "All this PDA, are you trying to make us single folks jealous?"

"That wasn’t my intention at all," Liu Banxia said. "Chatting with Qiaoqiao just helps me refresh my mind and avoid getting stuck in my own thinking."

"But how could those fungi reach his fingers?" Qiaoqiao asked. "They’d have to travel quite a distance, wouldn’t they? Shouldn’t they have infected other places along the way?"

"It’s not like poisoning in novels," Liu Banxia explained. "You can think of fungi as tiny boats floating through the blood vessels along with the blood. Wherever they happen to lodge, that’s where they’ll cause problems."

"Then what about his lungs?" Qiaoqiao frowned. "Wouldn’t they be a complete mess by now? It’s been so long; shouldn’t he have succumbed already?"

"Ah... Huh? Qiaoqiao, you’re brilliant!" Liu Banxia exclaimed, stunned for a moment. Then he let out a whoop.

It was a loud whoop. After shouting, he hugged Qiaoqiao and planted a firm kiss on her cheek. Then, he left Qiaoqiao standing there and ran off again.

"Ah... Um... He’s not usually like this," Qiaoqiao stammered, her face flushing beet red as she met Zhou Li’s gaze.

Indeed, he wasn’t usually like this. To be precise, for the past few days, they had only held hands. Liu Banxia’s sudden actions just now had left her feeling rather bewildered.

The "culprit," Liu Banxia, didn’t dwell on it. He found Xu Hui directly and also pulled Xu Guosheng from Cardiology.

"As the patient’s family member, I have a theory," Liu Banxia said seriously. "Could it be endocarditis causing the pneumonia and finger necrosis?"

"Bacteria adhering to a heart valve could have dislodged and traveled with the blood. If they went to the finger, they’d cause necrosis; if they went to the lungs, they’d cause pneumonia."

Xu Hui frowned. "You know, that’s actually very possible. Although we didn’t detect any abnormal heart sounds during the physical examination, he might be in the acute phase of the illness."

"That actually makes a lot of sense," Xu Guosheng nodded in agreement. "That would explain why his lung lesions progressed so rapidly. Perhaps the initial physical examination didn’t detect it for this very reason."

Based on this conjecture, Xu Hui hurriedly arranged for the relevant examinations. Even though the suggestion came from a "patient’s family member," it was highly plausible.

After all, the explanation that bacteria from a lung infection had traveled to the hand via the bloodstream seemed somewhat far-fetched. However, tracing it back to endocarditis made much more sense.

Liu Banxia felt a wave of relief. He had initially gone down the wrong path, focusing only on the lung inflammation and assuming the heart was fine. But what if the bacteria had indeed migrated extensively from the heart?

It was Qiaoqiao’s words that had jolted him. If the bacteria had originated in the lungs, he should have noticed something when he first met Zhang, as Zhang hadn’t shown any coughing symptoms back then.

Liu Banxia waited, feeling a sense of satisfaction despite the circumstances. Being suspended, he could only listen in and offer suggestions; he couldn’t get directly involved in the treatment.

After a round of tests, Xu Guosheng looked at Liu Banxia and shook his head. "Negative, it’s not endocarditis."

Liu Banxia was dumbfounded. He’d been so convinced it had to be endocarditis. Why wasn’t it?

"Although we still don’t have the blood culture results, judging from the current tests, the blood culture will likely also be negative," Xu Guosheng added.

Liu Banxia rubbed his face, racking his brain to recall all the internal medicine knowledge he had ever studied. He was still firmly convinced that the patient’s blackened finger had to be related to endocarditis.

Because after thinking it through, only that diagnosis could logically explain all the symptoms; the pneumonia explanation felt far too contrived.

"Damn it!" Liu Banxia looked up, his eyes shining. "Suppose the blood culture is also negative—isn’t there a type of culture-negative endocarditis caused by zoonotic pathogens?"

"High fever, pneumonia, potentially culture-negative endocarditis... Could it be psittacosis? If he had any contact with birds, he could have been infected. Plus, this disease can have a very long incubation period."

"We’ll check for that immediately." Xu Hui looked at Liu Banxia and nodded decisively.

Although it was still just a conjecture, it was a very plausible one. No one else had considered this angle; after all, it was somewhat rare to even see birds in a modern city.

No matter how bold Liu Banxia’s conjecture seemed, if there was even the slightest chance it was correct, it needed to be verified.