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March 4, 2022

Doctors diagnosed a woman with IBS. Two decades later, test results revealed a different diagnosis.

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on Aug. 31, 2022.

    Over the course of two decades, a 49-year-old woman had been tested for "every infection her various doctors could think of" and was still suffering from what they believed to be irritable bowel syndrome (IBS)—until test results revealed an entirely different diagnosis, Lisa Sanders writes for the New York Times Magazine

    Expedite patient diagnosis

    Two decades of 'intermittent misery'

    Although the patient's doctors worked hard to treat her IBS symptoms—including bloating, gas, occasional diarrhea, and frequent constipation—the patient was suffering from additional symptoms that could not be linked to IBS. "She had intermittent drenching night sweats, fatigue, brain fog, joint and muscle pains—and they came and went on a schedule all their own," Sanders writes.

    Since her diagnosis with IBS 24 years prior, the 49-year-old woman had seen rheumatologists and neurologists who ordered scans and scopes, blood tests and stool studies, a half dozen courses of antiparasitics and antibiotics. Unfortunately, after various tests and treatments, she was no better—and was worse in some ways.

    In fact, one of her doctors, a specialist in gastroenterology at Johns Hopkins Outpatient Center in Baltimore, told her, "We don't know what more we can do for you." Then, he suggested she try a different approach—an integrative-medicine branch that focused on using nutrition and alternative medicine to help patients get better.

    Following this recommendation, the woman went to see Wayne Bonlie, a family-practice physician who specialized in integrative medicine. During their initial visit, she detailed all the symptoms she had experienced over "two decades of intermittent misery," Sanders writes.

    According to the woman, everything started in 1998 during a trip to Mexico. She had diarrhea for a few days and had never felt the same since. Within weeks, she became sensitive to corn, then gluten, then dairy, and then fats.

    After being diagnosed with IBS, she started a diet that was low in certain types of gas-triggering carbohydrates. Initially, the diet helped. But the patient still couldn't eat most foods, including most fruits and many vegetables. Her diet was restricted to the few grains that didn't contain gluten, baked chicken or fish, and carrots.

    However, her symptoms often improved after she took antibiotics, which led her to believe that the condition she was suffering from was infectious. But she had already been tested for every infection her doctors could think of. 

    Testing for overlooked causes

    Although Bonlie wasn't sure if the woman had an infection or if her symptoms were entirely caused by IBS, he decided to test her for diseases that other doctors often overlook, including Lyme disease, ehrlichia, Bartonella, tularemia, and Epstein-Barr.

    According to her immune-system testing, she had been infected with a bug called Brucella—a bacterium that typically infects cows, sheep, goats, and pigs. It is usually transmitted to humans through the milk or meat of an infected animal.

    However, Bonlie noticed something strange about the woman's test results. The patient tested positive for Brucella despite not drinking any dairy, eating little meat, and not traveling outside the country in several years, but the findings suggested the infection was new, not old—even though the woman had had been experiencing symptoms for decades.

    Although troubled by the findings, Bonlie sent her sample back to the lab to measure the number of antibodies. When the level came back very high, Bonlie was convinced the patient had Brucella. He recommended two antibiotics—doxycycline and rifampin—to be taken over a six-week period to treat the infection.

    The patient then visited Mamuka Machaidze, an infectious disease specialist at Johns Hopkins. He was also troubled by the woman's strange testing pattern, but he too believed the high level of antibodies indicated the presence of a real reaction. He noted that it was possible that the positive result could have been triggered by a bacterium other than Brucella but decided to move forward with Bonlie's recommended treatment.

    'Whatever she had, she didn't have it anymore'

    Two months later, Machaidze saw the patient in a virtual visit just a few weeks after she finished the treatment. "It was one of the most gratifying encounters of his career. The patient was ecstatic. She hadn't felt this well in decades," Sanders writes.

    After finishing the antibiotics, the patient was no longer suffering from fevers, joint and muscle pain, or crazy sweating. She had even started adding foods back into her diet that she hadn't tasted in years.

    Machaidze sent her back to the lab where he discovered that even the antibodies that revealed her infection were gone.

    "Whatever she had, she didn't have it anymore. Was it Brucella? The patient thinks so. And Machaidze—well, he hopes so. But he recognizes that he will never know for sure," Sanders writes. (Sanders, New York Times Magazine, 3/3)

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