National Jewish Team Solves Inflammatory Mystery
Ralph Dinlocker is a powerfully built man who has always made time to work out. But when National Jewish Associate Professor Rohit Katial, MD entered the clinic room in May 2006 to visit the patient from Florida, Dinlocker was slumped over on the examining table, almost too weak to even raise himself. Dr. Katial knew he had to admit Dinlocker to the hospital right away.
Dinlocker had been diagnosed with asthma in 1981. But beginning in 2003 he began suffering a variety of seemingly unrelated symptoms. He had achy joints, skin rashes, problems breathing, numbness in the bottoms of his feet and pericarditis, fluid in the sac around his heart. In 2005, feeling unusually tired and weak, Dinlocker visited Mark Stein, MD, a former National Jewish fellow practicing in Florida.
Dr. Stein discovered a parasitic infection. But when therapy for that didn’t help Dinlocker’s symptoms, Dr. Stein sent him to National Jewish to see if we could figure out what plagued Ralph Dinlocker. Dr. Katial got the first clue from a blood test he ordered before admitting Dinlocker to the hospital. The blood test showed extraordinarily high levels of the inflammatory marker C reactive protein as well as large numbers of inflammatory cells called eosinophils.
Those results suggested some sort of vasculitis, an inflammatory process so aggressive that it enters the walls of the blood vessels. A skin rash that Dinlocker developed a few days later added more evidence in support of vasculitis. But then a skin biopsy failed to find the expected inflamed blood vessels.
Dr. Katial, rheumatologist Richard Meehan, MD, and cardiologist Howard Weinberger, MD discussed what to do next. They still thought Dinlocker might be suffering some kind of vasculitis but believed they had to look elsewhere for the inflamed blood vessels.
With his bad asthma and heart problems, the lungs seemed a likely place. That, however, would require an open-lung biopsy.“We are generally very hesitant to do such invasive diagnostic procedures,” said Dr. Katial. “But Ralph was really sick, and we needed to find out what was wrong with him.”
The lung biopsy revealed the suspected inflamed blood vessels, and cinched the diagnosis: Churg Strauss syndrome, a rare form of vasculitis that strikes 10 or fewer people in a million. Churg Strauss is characterized by late-onset asthma, pain or numbness in the extremities, rashes, and problems with the heart. The cause is unknown and there is no cure. Churg Strauss syndrome is almost always fatal if not properly treated. Immunosuppressive medications are effective, however, and patients often go into long-term remission.
Dinlocker was put on an immunosuppressive medication normally used to prevent rejections of organ transplants. Today, he is much healthier. Most of his symptoms have receded, he is much stronger, and has resumed athletic training. He is tremendously grateful for the persistence of the National Jewish staff and physicians.
“It was like having a team of really good detectives working together really well,” said Dinlocker. “Without them I probably would not have discovered what I have. They saved my life.”
