Clinical Cases

Siicea -A Non Excisional Therapeutic for Lymphadenopathy

Drs. Rakesh Gupta, Prabhakar Devadiga and Yarish Sadri  share a case of lymphadenopathy in a boy of 15. Perspiration of axillae, desires cold water and anger on contradiction were among the symptoms leading to the simillimum.

 Abstract– Post viral or bacterial lymphadenitis is a common sequel encountered in day to day practice and most commonly seen in the paediatric and adolescent age group due to lack of proper nourishment. 90% of the age group between 4-8 years present with lymphadenitis of acute origin whereas in adolescent age group chronic lymphadenitis is commonly viewed in today’s world.

In Tropical countries there is rampant tubercular lymphadenitis which needs to be diagnosed at the earliest to avoid spread to other organs. Proper homoeopathic treatment with proper clinical understanding replaces need for surgical excision.

Keywords- Boger, Hahnemann, Silica, Pathological, Kikuchi Fujimoto, Chronic, Cervical Lymphadenitis, Tuberculosis, Boericke, Phatak, Clarke, Materia Medica.

 Introduction– Bacteria such as tuberculosis, staphylococcus aureus, Streptococcus and viruses like influenza and Hemophilus A and B are known to cause chronic lymphadenitis in earlier age groups. Depending on the etiological factor the prognosis of the case is defined.

India being the epitome of tuberculosis, it has to be ruled out before treatment as it medicolegal responsibility to notify case of tuberculosis to prevent its spread further and to establish and identify cases of drug resistant tuberculosis.

 Case History-

A 15-year-old boy comes to the OPD with chief complaints of

swelling on right side of the neck since 3 weeks <4-5 days

O- Gradual P- Increasing

Sensation- Pain on pressure

> applying Balm

H/O- Fever (1 episode) 2-3 months back with Weakness and Fatigue

No H/O- 1. Cough

  1. Coryza
  2. Weight loss
  3. Night sweats

Patient As A Person: –

Likes- Sweets ++

Thermal Reaction- HOT+3

Past History – Malaria 5-6 years back

Family History- Grandmother- Hypertension and Diabetes

Mental Characteristics-

Anger++ when someone blames him for something he hasn’t done. Retaliates by shouting at them without any grudges.

 Investigations (7/5/2021)

CBC

  1. Hb- 13.1 g%
  2. RBC count- 5.23 million/cu mm
  3. Total WBC Count- 6900/cu mm
  4. Platelets- 186000/cu mm

ESR- 10 mm at 1 hour

Local examination-

Inspection-

  1. a circular mass on the right side of neck just below the angle of mandible
  2. Skin colour
  3. Size- 2-3 centimeters in diameter.

On Palpation-

  1. No heat
  2. Consistency- Firm
  3. Fluctuant mass
  4. Tender on pressure

Lymph nodes- Mildly palpable on both sides (but not visible)

Investigations Advised-

  1. Fine Needle Aspiration – Rule out Kochs
  2. X ray chest PA View

(Patient had already been to a surgeon and he had advised to get a biopsy done but the relatives didn’t want to get any operative procedure done so they denied to get an FNAC done)

Fig 1. Right Cervical Lymphadenopathy.

Figure 2: – X- Ray Chest PA revealed increased bronchial markings. Both costophrenic angles normal.

Differential Diagnosis

  Kikuchi- Fujimoto Disease

(histiocytic necrotizing lymphadenitis)

Chronic Cervical Lymphadenitis (Reactive Lymphadenitis)

 

Tuberculous Lymphadenopathy
Origin Rare- autoimmune/viral-

Epstein Barr, herpes zoster.

Common in Adolescent Asians

 

Bacteria, Viral

Staph Aureus, Streptococcus Influenza, etc.

Mycobacterium Tuberculosis
Symptomatology Benign condition presenting with lymphadenopathy, mild fever, rash, night sweats, myalgia  and systemic symptoms.

Duration- 2-3 weeks to develop

Resolution- 3-4 months

 

Fever- mild or high grade

fatigue, Weakness

 

Fever, night sweats, weight loss, fatigue, anorexia, hemoptysis, cough with expectoration.

 

Location

And

Tenderness

Unilateral Lymph node swelling- above clavicle, posterior cervical and in axillae.

 

Tender lymph nodes

Unilateral or Bilateral lymphadenopathy

 

Mycobacterium TB affects the deep cervical, mesenteric and ancillary lymph nodes.

Matted lymph nodes (Conglobated)

Non tender

 

FNAC reveals necrotic tissue with karyorrhexis. Non necrotic tissue Necrotic tissue with giant cells presents.
CT Scan Non specific

Homogenous nodal enlargement

Perinodal infiltration

Central Nodal necrotic changes

Non necrotic homogenous nodal enlargement. Necrotic Lymph nodes

With or without caseation.

conglobate/Matted lymph nodes.

 

WBC count Reduced Increased or Normal Increased

Provisional Diagnosis: Chronic Cervical Lymphadenitis, ICD Classification – I88.1

Reasons-

  • Time duration- 3 weeks
  • No signs of acute inflammatory changes
  • Tenderness is present at the site.
  • No night sweats, sudden weight loss, anorexia,
  • ESR- 10 mm- TB lymphadenopathy ruled out.

Hahnemannian Disease Classification- Dynamic, Chronic, Miasmatic with fully developed Symptoms.

Paucity of Symptoms

One comes across cases in which, in spite all the efforts of a physician, the case record is very poor in symptomatology. The symptoms that depict the individual are conspicuous by their absence. The few symptoms that are available indicate merely the changes that occurred in tissues and organs.

Miasmatic Understanding:-  

Fig 3: Miasmatic Understanding.

Boger’s Approach

“With an enormous increase in available pathogenetic symptoms we do not feel this need so acutely, albeit often to our own disadvantage. Most prescribers gradually enlarge the scope of their remedies quite beyond their seemingly legitimate sphere of action. This springs from the fact that the simillimum releases reactive power strong enough to re-establish harmony, which in turn is capable of sweeping away almost any morbid condition.”

Totality-

  1. Anger- contradiction from
  2. External throat Right Cervical glands swelling
  3. Pain in cervical glands
  4. Thirstless
  5. Perspiration- axilla
  6. Sweets desire
  7. Hot patient

Fig 4: Reportorisation sheet.

         Lycopodium

(Psora-Sycotic)

Ambithermal

              Silicea

(Tubercular)

Chilly

 

          Nitric Acid

(Syphilitic)

Chilly

 

Constitution Malnutrition with gastric disturbances. Carbo-nitrogenoid constitution. Right Sided Malnutrition due to imperfect assimilation. Organic changes deep and slow. Scrofulous.

Right Sided

Affinity for margins of orifices with additional effects to glands.

 

Particular Emaciation about neck. Feels stiff and swollen.

Profuse Sweat of Feet

Hard cold swelling of the cervical glands.

Profuse Offensive sweat of Feet and Axilla.

Stiffness of neck. Swelling of both glands cervical and axilla.

Offensive sweat in axilla at night.

Mind Head Strong. Haughty when sick. Little things annoy him. Extreme sensitiveness. Yielding

Headstrong children

Weakness of memory

Irritable

Hateful

Vindictive

Headstrong

Generals Thirstless

<cold water

Desire for Sweet things

Thirsty

Desire cold water

Desire Ice cream

Thirsty

Desire- Salt and Fat

Aversion- Sweets

 Table 1: Differentiation of the remedies

Remedy- Silicea

REASONS-

  • Hard swelling of cervical glands
  • Malnutrition of children
  • Perspiration of axillae
  • Desire cold water
  • Anger on contradiction
  • Kents Materi medica has mentioned that there is extreme heat intolerance in Silicea Patients.

Susceptibility- Low

  1. More pathological symptoms compared to generals.
  2. No characteristics seen at the level of generals.
  3. No prodromal symptoms seen.
  4. Chronic Disease
  5. Slow Pace of disease
  6. Low Sensitivity at the level of mind and body

POSOLOGY- SILICEA 30 qds

REASONS-

  • More pathogenetic symptoms than general symptoms
  • Low Susceptibilty
  • Absence of prodromal and functional symptoms
  • Syco- Tubercular Miasm

Reference (Symposium Volume 2)

Pathological Prescribing- At times in a chronic case with advanced pathology, there is a lack of clear cut indications for the chronic constitutional prescription, due to paucity of characteristics and concomitants. The striking pathological condition indicates the remedy in such cases. It needs to be prescribed frequently in low potency.

 Ancillary Mode of Treatment-

  • Vitamin Supplementation- Vitamin C, Vitamin B12, Vitamin D3 and Calcium.
  • Proper nutritious balanced diet to be followed.
  • Add protein to diet to build immunity.

Follow Up Criteria-

  • Swelling of the right side of neck
  • Generals
  • Any New Complaints

Fg 5: 22/5/2021

 

19/5/2021 1.     Swelling of right side cervical lymph nodes

-SQ-

2.     Generals – N

MRI (15/5/2021)

Few mildly enlarged and sub centimeter sized non necrotic lymph nodes are seen on rt side of neck at the level of II, III, V. No hilar or mediastinal lymphadenopathy. No pulmonary Abnormality.

Rx

Sil 30

3 pills every 1 hourly

x4 days

22/5/2021 1.     Swelling of right-side cervical lymph nodes

->- 40%

2.     Generals – N

Rx

Sil 30

3 pills every 1 hourly  x7days


Fig 6: 29/5/2021

29/5/2021 1.     Swelling of right-side cervical lymph nodes

->-70%

2.     Generals – N

Rx

Sil 30

3 pills every 1 hourly

x4 days

 

2/6/2021 1.     Swelling of right-side cervical lymph nodes

->- 80-85%

2.     Generals – N

Rx

Sil 30

3 pills every 2 hourly x7days

 

12/6/2021 1.     Swelling of right-side cervical lymph nodes

->- 90%

2.     Generals – N

Rx

Sil 30

3 pills every 4 hourly x7days

 

Case Learning-

  • Application of Boger’s Approach in pathogenetic conditions
  • Prescribing when there is paucity of symptoms
  • Clinical approach to lymphadenitis cases
  • Miasmatic Study- Syco tubercular miasm.

Acknowledgement: –

We thank Dr Mohanbhai Patel, Chairman, The Homeopathic Education Society (Smt. Chandaben Mohanbhai Patel Homeopathic College), Dr Asmita Parikh; General Secretary, The Homeopathic Education Society (Smt. Chandaben Mohanbhai Patel Homeopathic College) and Dr Parizad Damania- Principal, Smt. Chandaben Mohanbhai Patel Homeopathic College for the encouragement, support and hospital infrastructure.

Corresponding author:  Dr Rakesh Gupta, President of Satva Charitable Sanstha. HOD and Associate Professor, Forensic Medicine and Toxicology, Smt Chandaben Mohanbhai Patel Homeopathic Medical College, Mumbai, India.

BIBLIOGRAPHY-

  1. PJ Mehta’s, Practical Medicine by SP Mehta, SR Joshi, Nihar P Mehta 20th Edition Page number- 24
  1. Kikuchi- Fujimoto Disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1481509/#:~:text=Kikuchi%2DFujimoto%20disease%20(KFD),nausea%2C%20vomiting%2C%20sore%20throat.

  1. M. Boger, Studies in the Philosophy of Healing, 2nd Edition Page number 28-36
  2. Das, A Manual on Clinical Surgery, 9th Edition Page number- 117-118
  3. Boericke’s, Pocket Manual of Homeopathic Materia medica with Repertory and a chapter on rare and uncommon remedies with Indian Drugs by W. Boericke, MD 9th Edition page number- 590-594
  4. Dr S.R. Phatak, Materia Medica of Homoeopathic Medicines- Second edition Revised & Enlarged, 2nd Edition page no- 645-651
  5. A Dictionary of Practical Materia Medica Vol 3, By Dr John Henry Clarke M.D Student Edition page number- 1175-1189.
  6. Synthesis repertory
  7. Classic Hompath
  8. Dr M.L. Dhawale, Principles and Practice of Homoeopathy Part 1, 2nd Edition Page 58
  9. ICR Symposium Volume On Hahnemannian Totality Part 1 AREA C Perceiving Miasmatic Evolution- C.23-C.27, C.30
  10. ICR Symposium Volume On Hahnemannian Totality Part 3 AREA G Perceiving: Practice Standardization Of Individualization- G.41
  11. T.Kent, Lectures on Homoeopathic Materia Medica, B Jain, 12th Impression, 2014,Page 931.

About the author

Rakesh Gupta

Dr. Rakesh Gupta MD(Hom) Practice of Medicine, MBA (HCS), FLP (KPMG), SCR. HOD Forensic Medicine and Toxicology, Smt Chandaben Mohanbhai Patel Homeopathic Medical College, Mumbai, India. President, Satva Homeopathy and Satva Charitable Sanstha, Mumbai, India.

About the author

Prabhakar Y. Devadiga

Dr. Prabhakar Y. Devadiga - Professor and Hod - Organon
Smt. Cmp Homeopathic Medical College.

About the author

Yarish Sadri

Dr. Yarish Sadri -Intern, Smt Chandaben Mohanbhai Patel Homeopathic Medical College, Mumbai, India and Publication Coordinator at Satva Charitable Sanstha.

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