Doctors haven’t been able to work out the cause of a young woman’s medical symptoms, and now the New York Times is appealing to the public for suggestions. This article is a summary of the original, and you can read the full account and submit your diagnosis here.
Angel is 23 now, but she has been experiencing muscle pains all her life. The painful ‘episodes’ became more severe when she was 14, and one night she woke up in the middle of the night from pains in her legs. That was the first time she was brought to the hospital because of it. The episode had come just after she had been to the doctors for another reason; she had been ill and was diagnosed with sinusitis and an upper respiratory infection. The doctor had given her antibiotics and antihistamines to take, and she was still on that course of treatment when she was admitted to Summerlin Hospital in Las Vegas for her leg pains.
Angel’s symptoms at the hospital were unusual. Her urine was dark, about the color of cola. This can happen following muscle destruction when the proteins that turn muscle red are removed from the body through urine. To confirm that her muscles had been damaged, hospital doctors measured levels of the protein creatine kinase (CK) in the blood. The normal processes of muscle wear and repair mean that CK is always in the blood, usually at levels between 96-100 units per liter. However, when Angel was tested she was found to have levels over 24,000.
This score showed that her muscles were being significantly broken down, at a level that is referred to as rhabdomyolysis, or rhadbo for short. It is known to be caused by events that cause a high level of muscle damage, such as surgery, severe accidents like car accidents, and, less commonly, by drugs, alcohol, extreme exercise, and some infections. Since the first five causes were ruled out, doctors began to test her for possible infections. She was found not to have the bacterium that causes strep throat or any other clear cause of the rhadbo. After being treated with intravenous (IV) fluids she was sent home. Doctors thought that it was probably caused by a viral infection and would be a one-time occurrence.
However, it continued to affect her. The next recurrence was just two months later. She was brought to the hospital and her CK levels were again extremely high, this time over 60,000, indicating rhadbo. After a few days and treatment with an IV it went away again. The reappearance of the condition suggested that it wasn’t caused by a viral infection, but doctors were unable to come up with a better explanation.
Since then, Angel has suffered from frequent low-level muscle pain, with occasional episodes of severe pain that send her to hospital. The painful episodes have sometimes coincided with taking antibiotics. When she was 17 and had a sore throat and fever, she was given antibiotics. The following day she felt muscle pains and the day after she showed the signs of rhadbo again. At the hospital, she was treated and given more tests. The tests for strep, lupus, and thyroid disease, all of which can result in rhadbo, were negative. Furthermore, an infection seemed increasingly unlikely given that, at this point, she had had three episodes of rhadbo over as many years.
Further testing didn’t help doctors to diagnose her. An M.R.I. brain scan didn’t show anything unusual, and neither did tests for autoimmune liver diseases, an abdomen ultrasound, or two muscle biopsies. Other plans to meet with doctors and undergo tests when she is feeling healthier and living at home have been frustrated by her frequent re-admittance to the hospital for severe muscle pain.
