Pyrexia Of Unknown Origin.
NATIONAL JOURNAL OF HOMOEOPATHY 1996 May / Jun Vol V No 3.
Seshadri G R.
Cases.
` Tub / Anthr / Dros.

It is a fundamental axiom of Homoeopathy that mentals are vital in providing light to the physician in the choice of remedies. While this is usually true yet in many chronic ailments, the physical symptoms often provide crucial therapeutic clues. The following case illustrates this point.

Mr. G, aged 36 was suffering from evening rise in temperature for 45 days. Not getting any relief in Dubai arrived in Delhi on January 30, 1996. The fever always started in evening with sweating the following morning. His problems started from September 1995 when he was in Bombay. First he had severe stomach pain soon after eating food. At that time he was treated for amoebiasis and peptic ulcer by allopathic doctors but the relief was temporary. In this condition he went back to Dubai and in the following weeks the low grade evening fever started. he underwent innumerable tests, in India and in Dubai. Stool test, Barium meal with follow-through, Tuberculin (Mantoux test) and even test for AIDS proved negative.

RAPID EMACIATION:

Meanwhile, he was rapidly losing weight and appetite. So after the failure of usual medications, the Dubai doctors in spite of negative Mantoux, started anti tubercular therapy (AKT) consisting of Rifampicin, Ethambutol and INH. No improvement after 22 days he came to Delhi. a skeleton on a wheel chair, for specialist consultation. The specialist diagnosed the patients ailment as Fever of Unknown Origin (PUO) and advised continuation of AKT (with the addition of Pyrazinamide) for a week more. If no improvement, he was then advised admission in the All India Institute of Medical Sciences for liver biopsy and bone marrow tests. During this period the patient had already lost 16 kg and had no appetite. He could not tolerate even a slight whiff of cold wind and insisted on closing all windows and doors.

A LIMP AND A STOOP:

Meanwhile, the patient developed a limp as a result of severe pain in the right hip joint. The limp became a stoop whenever he attempted to stand. The Orthopaedic diagnosed the problem as flexion contracture and a CT Scan was taken on February 12 1996. It showed evidence of right sided hydronephrosis and hydroureter. In the pelvic region, there was a lesion involving the ileo-psoas muscles and there was an abscess in the right iliac fossa.

It was at this time that the patient approached me (I was in Delhi at that time) for Homoeopathic treatment. He had no history of TB, either in him, his parents or near relatives. Fortunately, all the tests carried out till then were non-invasive. The low-grade evening fever (100 degree to 101 degree fever) every day, remission with profuse perspiration, rapid emaciation and weight loss seemed to indicate tubercular miasm.

TREATMENT AND FOLLOW-UP

February 12/96: X-Ray 200 to neutralize the deleterious effects of CT Scan and earlier X-Ray exposures.
February 14/96: Drosera 200 OD for two days. Within a few hours after the first dose,, there was relief in the pain in the hip joint and the patient was able to walk a few yards without stooping ! But the low-grade evening fever continued.
February 20/96: Tuberculinum 200, one dose. No fever from the next day.
February 26/96: Anthracinum 200 OD for 2 days for the Psoriasis abscess.
February 29/96: Drosera 200 OD for 4 days.

The patient showed daily improvement since then (after a mild aggravation initially). The colour returned to his cheeks. No fever, no hip or stomach pain. His healthy appetite returned. Margaret Tyler says in her "Homoeopathic Drug Pictures" that "where Drosera helps, results are seen very soon and invariably in renewed health and spirits. The patient who needs Drosera and gets it simply blooms". In Materia Medica Pura. Hahnemann gives big black type not only to whooping cough (for which Drosera is a near specific) but also to pains in joints, hip, ankles and in the shafts of long bones.

He gained 12 kg in six weeks by the time he left for Dubai on April 20/96. On June 4, 1996 he rang up to say that he was fit as a fiddle.

INDICATIONS FOR REMEDIES USED:

DROSERA:

1. Paralytic pain at right hip joint, thigh and in ankles; when walking he must limp on account of pain (M L Tyler).
2. Pains about hip joint,, tubercular glands (Boericke).
3. Paralytic pains in coxo-femoral joint and thighs. Bed feels too hard. (Boericke).

TUBERCULINUM: Low grade evening fever of a remittent type. Tuberculinum is complementary to Drosera and as Tyler says "they seem to play into each others hands especially in cases of tubercular bones and glands".

ANTHRACINUM:

All inflammation of connective tissue in which there may be a purulent focus (Boericke).

Septic inflammation, malignant ulcers, abscesses (Boericke).

NB: The patient has been advised to continue antitubercular therapy, consisting of rifampicin, ethambutol and INH by the specialists in Delhi. According to me, the treatment is complete. Will some learned Homoeopath with an allopathic orientation like Dr Chimthanawala give his opinion on the advisability of continuing.

REFERENCES:

1. Boerickes Materia Medica.
2. Homoeopathic Drug Pictures by Margaret Tyler.
3. Keynotes of Leading Remedies by H. C. Allen.

EDITORS COMMENTS:

1. Excellent case.
2. The first prescription of X-Ray holds no ground as no symptoms developed after X-Ray and CT Scan. The remedy also did not show any abatement of symptoms after being administered. A totally empirical remedy selection can be avoided, especially where indicated remedy picture is clear.. This applies to Anthracinum too. Drosera and Tuberculinum would have been enough to complete the case.
3. Anti-Kochs treatment, which was anyway empirically given, can be safely discontinued, as all symptoms of the patient have improved.
4. Tub-b in ascending potencies, following Kents schedule the cure. (2 doses of every potency every 6-8 weeks 1M to CM).