Dr Cabot’s Case Histories

Many of my patients come to see me asking for help with their immune system because they suffer with some chronic problem or an underlying fragility that makes them prone to recurrent inflammation or infections. Antibiotics and anti-inflammatory drugs may have helped them to some degree, or in some cases have made them worse, and they realise that they need to turn to nutritional medicine to strengthen their immune system.

Let’s look at some fascinating patients whose cases illustrate what can go wrong when the immune system malfunctions and the wrong treatments are used.

Joanne aged 37, mother of two children and a professional woman working in the health industry.

Joanne came to see me for an unusual auto-immune disease known as Leukocytoclastic vasculitis – wow that’s a mouthful! What does it mean?

From now on let’s abbreviate this disease to (LCV). In Joanne’s case this disease came on within a week of having her 18th annual influenza vaccine and manifested as fever, extreme fatigue, body aches and pains, headache, abdominal pain and a rash consisting of smallish purple spots on her lower abdomen and limbs. The cause of all these symptoms was acute inflammation attacking the tiny arteries that supplied her brain, abdominal organs and limbs. The purple spots were bruises caused by the rupture of the tiny blood vessels (capillaries) in her skin. To suppress the inflammation the doctor gave her a steroid tablet known as prednisolone and after a few weeks the symptoms went away. When Joanne asked the specialists if this disease had been brought on by the influenza vaccine, she got a blank stare and indeed every doctor she asked this question, gave her a blank stare and a non committal “I doubt it”; notwithstanding Joanne will never have another influenza vaccination and neither would I!

Unfortunately for Joanne the LCV kept recurring every few months over the next 4 years, and she gradually deteriorated and developed a tremor in her right hand, memory problems, a stutter and chronic fatigue. She had to sell her business and give up work and spent a lot of the day sleeping in between looking after her children.

Joanne came to see me with great hope and I believed I could help her slowly restore her health and at least prevent progression of the disease. We would aim for less frequent and less severe recurrences of the vasculitis and look for any other causes of vasculitis.

Joanne had extreme inflammation occurring in the small arteries all over her body and I devised a program to reduce this inflammation; let’s take a look at my plan:

Liquid fish oil – one tablespoon three times daily, just before meals. These larger doses of fish oil were essential to provide anti-inflammatory omega 3 fatty acids to her blood vessels. The fish oil would also thin the blood enabling a better peripheral circulation and less tendency to form blood clots in the tiny arteries.

Antioxidant supplements of:

Vitamin C 1000mg three times daily to reduce free radical damage to the vessel walls

Vitamin E 1000 I. U. to protect the lining of her arteries

Selenium 200mcg daily and zinc 30mg daily to reduce free radical damage inflicted on the arteries and to calm her immune system down.

Raw juices made with pineapple, cabbage, carrot, orange, lime, lemon, capsicum and chives. The juices would concentrate the antioxidants from these vegetables and fruits and if she drank 400mls everyday the inflammation in her blood vessels would be much easier to control.

Causes of LCV
Leukocytoclastic vasculitis can be caused by many medications (such as antibiotics etc.), auto-antigens or infectious agents such as bacteria and viruses. Immune complexes lodge in the vessel wall, attracting polymorphonuclear leukocytes (white blood cells) that in turn release tissue-degrading substances leading to an acute inflammatory process.

Patient Presentation
Painful and lumpy bruises (known as petechiae or purpura). These bruises or spots normally arise in crops, with common localizations being the legs, lower abdomen and forearms. Necrosis (destruction) of skin tissue can produce spots and/or bruises with black or brown centres. This disorder may affect the skin only, but sometimes can affect the tiny blood vessels that supply the nerves, the kidneys, joints and the heart.

Investigations in those with LCV
The most important thing is to identify the causing agent, be it a drug or a microorganism or viral antigen (such as a vaccination). A good history is important, as is a thorough physical examination, chest X-ray, ESR and biochemical tests of organ function, especially the kidneys. Skin biopsy of the lesions reveals inflammation of the small blood vessels, termed leukocytoclastic vasculitis (LCV), which is most prominent in postcapillary venules. Tests for hepatitis virus, antinuclear antibodies, rheumatoid factor and cryoglobulins might be indicated.