A Rare ComplicationDoctors from Baylor College of Medicine published 2 research papers describing the unusual case of a 38-year-old Honduran housekeeper with multiple comobordities who died from a disseminated parasitic infection. Upon autopsy, pathologists found that the patient's intestines, liver and lungs were infested with Strongyloides stercoralis.
The plaintiff's attorney argued that the doctor could have recognized the infection of they had thought about it in their differentials and quoted the published case reports.
The jury awarded close to $ 900,000 to the family of the deceased patient.
During her 48-hour hospitalization, she was seen by multiple subspecialists (rheumatology, GI, cardiology, radiology, surgery, neurology, internal medicine and dermatology) — 32 physicians and residents in all, but nobody was able to figure out the rare diagnosis.
What Was Missing?
The only consult missing? ID.
Patient's eosinophilia was a clue to the parasitic infection.
Of course, it is very easy to recognize the signs and symptoms of a diagnosis when you know the autopsy conclusion and you look back at the case. It is much more challenging to pinpoint the correct diagnosis in "real time" in patients who have several concurrent diseases.
A Case with a Bad Outcome - To Publish or Not To Publish?
Should you publish a case report during a course of a litigation dealing with the same case? It is probably not a good idea.
On the other hand, doctors have to learn from their or others' mistakes. That was the probable reason why the Baylor researchers decided to publish the case reports: to help other physicians reach the correct (and rare) diagnosis in time. Unfortunately those same reports backfired in court.
References:
Link via Kevin, M.D.
Baylor's own scholarship works against it in lawsuit. Research about a rare and possibly misdiagnosed case was used to show negligence. The Houston Chronicle, March 11, 2006.
Strongyloidiasis from Wikipedia, the free encyclopedia.
Image source: CDC, public domain.