Chapter 112:
Leland froze. He snatched up the report and flipped through it with trembling fingers. Buried in all the technical language, the glutamate levels were clearly flagged as dangerously high.
He stammered, “But… this treatment just feels too extreme.”
“I’d rather gamble with recovery than watch him waste away in a coma,” she said. Rylie clicked her pen shut. “Typical immunosuppressants won’t work this time. There’s over seventy percent damage to his blood-brain barrier. What matters now is bringing back protection for his neurons, not dragging out more immune suppression.”
Leland’s mouth opened, but no sound followed. There was nothing he could say to counter her logic. That’s when it hit him. He’d been clinging to textbook answers for too long, forgetting that every patient carried their own puzzle.
He pointed at one of the drugs in her second plan. “Why would you even use doxycycline? That’s not for neurological issues.”
Rylie’s lips curved, just slightly. “You really should keep up with Frontiers in Neuroimmunology. The latest volume has a whole piece on this.” She pulled up the study on her tablet. “Silvercrest University found that this class of antibiotics helps regulate neuroinflammation. Especially when it stems from something like a mycoplasma infection. Just like in his case.”
Leland took the tablet from her and read the summary. His brows drew together as he tried to absorb the findings. Those studies had always felt outside his lane. He’d skipped over them.
“I’ll need time to look through these properly,” he said, struggling to admit it.
“We’re out of time.” Rylie closed the tablet. “Let’s move to the next one.”
Their second patient wasn’t any easier to figure out.
Leland stared at the brain scans. Diffuse lesions stretched across the cortex. Sweat gathered on his brow as he leaned in closer. “This almost resembles prion disease, but something doesn’t line up.”
Rylie was already pulling on gloves. She stepped over to the patient and began checking his skin. “It’s not prion-related.” She pointed to a patch on the arm. “These tiny rashes? Capillary dilation.” Then she gently opened one eyelid. “See this? The blood vessels in the conjunctiva are abnormal.”
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He leaned over to inspect them himself. She was right. The signs were clear now that he looked closer. “What does that mean, exactly?” he asked.
“Brain ischemia from vasculitis,” Rylie answered, jotting notes on the plan. “We’ll still need imaging to confirm it, but this points to a rare form of ANCA-related vasculitis.”
“Hold on!” Leland cut in. “If this really is vasculitis, then why didn’t the others catch it? The standard ANCA results were negative!”
Rylie exhaled sharply. “Because all they did was run the usual panel. This strain doesn’t show up there. You need a specialized ELISA test to trace antibodies that target membrane protrusion proteins.” Rylie turned the results toward him as she added, “Look at this. His complement levels are way below normal. That’s a major indicator.”
The room tilted slightly as Leland processed it. His vision wavered. Those same numbers had been in front of him. He just hadn’t connected the pieces. Rylie had a way of cutting through the noise. It was as if she could see the disease bare and unfiltered.
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