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A patient gets her life back - Clinical Case Studies - Vol. 1

I’ve got my life back! Such was the joy of the 48 year old Mrs B.R.

Over a ten year period, she had suffered increasingly from three major symptoms – headaches, memory loss and general fatigue.

She had been investigated and found to have fairly normal blood tests and a normal brain scan. Her physicians had, however, picked up three clues – firstly, a cold, blotchy circulation, secondly, severe memory defects on formal testing and thirdly, dry, gritty eyes. The penny dropped and she was found to have positive tests for aPL and for Sjogren’s Syndrome.

She was started on a low dose of aspirin, but with little in the way of improvement. While on a six month family stay abroad, two additional changes were made – a three week trial of heparin, and the addition of quinine (Plaquenil) – an important treatment for Sjogren’s.

The effect of the short trial of heparin was startling – the memory loss defects and the word finding problems improved and the headaches all but disappeared.

Back home, she was switched to warfarin. She is now back at work in a law firm, having got her ‘life back’.

What is this patient teaching us?

Two big lessons – firstly the profound effects which Hughes Syndrome can have on the brain – with migraine and memory loss being both frequent and severe – and the unbelievable improvement which treatment can produce.

Secondly, the link with Sjogren’s Syndrome. This syndrome (dry eyes, dry mouth, fatigue and aches and pains) is a ‘cousin’ of lupus – less dangerous perhaps, but often undiagnosed.

Plaquenil (derived from quinine – from the bark of the Cinchona tree, is a very useful (and safe) medicine, especially good in reducing the fatigue of Sjogren’s.

I sometimes think of my patients with Hughes Syndrome and Sjogren’s being treated with ‘two trees’ – aspirin (willow tree) and Plaquenil (Cinchona).

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.


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