A 40 year old male patient presented in the out-patient Male Medicine of MBH Medical College and Hospital, Howrah with dyspnea and productive cough for last 5 years with history of recurrent catarrh and pulmonary tuberculosis at the age of 35. He was treated with conventional drugs with minimal improvement and recurrences. Baseline HRCT scan showed bilateral lower and right middle lobe bronchiectasis (Fig. 1, 2), USG abdomen and CXR showed situs invertus (Fig. 3, 4), spirometry revealed restrictive pulmonary dysfunction (FEV1/FVC 48.57) (Fig. 5), maxillary sinusitis on skiagram, and azospermia on seminal analysis. Apex beat was right-sided with wheeze, crackles, and tenderness of maxillary sinuses. Case recording and repertorization were done as per homeopathic principles and Tuberculinum bovinum was prescribed in 50 millesimal scales.
Totality of Characteristic Symptoms is as follows:
(1) The patient desires to travel to different places and he changes his profession very frequently.
(2) The patient’s tendency to take cold easily.
(3) Desire for smoked meat, fat, salty food, ice creams, aversion to bitter things.
(4) Fear of dogs and especially cats are marked.
(5) Strong sexual desire (though he is azospermic).
(6) The patient is chilly in thermal reaction.
(7) Intelligent, sensitive, irritable over daily circumstances.
(8) Cough, cold are aggravated by the least changes of weather.
(9) Rattling of chest.
(10) Dyspnoea with cough while lying down.
Constitution of the Patient: Lean, thin, emaciated (but he craves fat) fatty food and meat.
Personal History of Tuberculosis: At age 35 this was treated by ATD (Anti Tubercular Drug).
Miasmatic Background: Predominantly psora mixed with syphilis.
Appropriate evaluation of symptoms is done on the basis of Kent’s Philosophy.
Repertorisation had been done by consulting Kent’s Repertory (Repertory of the Homoeopathic MateriaMedica).
Rubrics chosen from the repertory are as follows:
- Cosmopolitan (see travel) Mind
- Fear of Dogs Mind
- Sensitive – oversensitive; external impression to all Mind
- Industrious Mind
- Mood – Changeable variable Mind
- Desire for smoked meat Stomach
- Desire for fat Stomach
- Desire for ice creams Stomach
- Desire for salty thing Stomach
- Cold tendency to take Generalities
- Heat, vital, lack of Generalities
- Sexual passion increased Genital
- Cough, weather change of Cough
- Rattling Respiration
- Respiration difficult lying while Respiration
After critical analysis of the repertorial result and consultation with the source book of Materia Medica we prescribed Tuberculinum, O/1, 14 doses in 4 ounces of Distilled Water for consecutive days. We considered the constitution of the patient, personal history of TB, after matching with the miasmatic as well as disease pathology.
Clinically the patient improved after 1 year of treatment, as evidenced by changes in 100mm VASs (dyspnea 78mm vs. 23mm; cough 73 mm vs. 18mm; fatigue 83mm vs. 27mm); mBorg (6 vs. 1); UCSD-SOBQ (89 vs. 38); 6 minutes walk test (422m vs. 661m); and KS symptoms score (22 vs. 5). After treatment spirometry revealed FEV1/FVC 64.78 and obstructive defect with reversibility (Fig. 6). Thus homeopathy helped to alleviate KS complaints.
Fig. 1, 2: HRCT scan of lungs shows bronchiectasis changes
Fig. 3: USG showing situs invertus, liver on the left and spleen on the right
Fig. 4: Chest X-ray showing dextrocardia and bronchiectatic changes
Fig. 5: Pre-treatment spirometry: FEV1/FVC 48.57
Fig. 6: Post-treatment spirometry FEV1/FVC 64.78