Vishma's story: a mystery solved.

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Date: Aug. 29, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 33)
Publisher: CMA Impact Inc.
Document Type: Personal account
Length: 1,803 words
Lexile Measure: 990L

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Vishma was born in Toronto to parents who had immigrated from Trinidad and Tobago. Her childhood was filled with family, friends and fun. When she was 19 years old, she had a daughter and graduated from high school. She subsequently got her undergraduate degree and began her career in sales and advertising.

Things were going well until she was 27 years old. After a trip to Trinidad, she developed fatigue, fever and unexplained weight loss. For more than a month, she sought help in many hospital emergency departments. A week-long admission to investigate the fever of unknown origin did not yield a diagnosis. It was only when she was in kidney failure that a diagnosis of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis was made. Vishma was treated with plasmapheresis, high-dose pulse corticosteroids, rituximab, cyclophosphamide and azathioprine. Her clinical course was complicated by an intracerebral hemorrhage and methicillin-resistant Staphylococcus aureus discitis. During the year after diagnosis, she had many admissions to hospital, an admission to the intensive care unit and inpatient rehabilitation.

Eventually Vishma's disease went into remission. Presently, she has no symptoms or signs of vasculitis, has stable stage 2 chronic kidney disease and takes maintenance azathioprine and antihypertensive medications.

Patient's perspective

Like many people my age, I was building my career by working and studying. I was a strong person and strived to do things for the people I loved.

It was roughly 5 months from the start of my symptoms to the time of diagnosis. I had fever, cough and weakness and was unable to keep food down. I lost around 60 pounds and was afraid of my own reflection. I was in agony. I felt hopeless, weak and ashamed that I needed help to bathe and get to the toilet. Visits to walk-in clinics, emergency departments, churches, priests, astrologers and spiritual healers did not help. I felt like a burden to those around me. I was terrified that I would be swept under the rug and forgotten, and that my daughter would grow up and not remember me. I knew that if they didn't figure it out, I would die. I was afraid to die--maybe because I thought of myself as the strong one.

I went to one last hospital and that was where I met Dr. Etchells and his team. He told me that my kidneys were failing. I was sure he was mistaken, but he wasn't. Thankfully, the results of one of the tests from 2 weeks before became available and gave the doctors some indication of how to treat me. I was transferred to another hospital to have plasmapheresis. I ended up having a stroke, which affected my vision, and then developed a spine infection...

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Gale Document Number: GALE|A715388499