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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 14  |  Issue : 4  |  Page : 287-292

Pelvic inflammatory disease treated with homoeopathic medicine Calcarea carbonica: A case Report


Department of Case Taking and Repertory, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah, West Bengal, India

Date of Submission12-Jun-2020
Date of Acceptance27-Nov-2020
Date of Web Publication29-Dec-2020

Correspondence Address:
Dr. Raj K Pandit
Department of Case Taking and Repertory, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijrh.ijrh_60_20

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  Abstract 


Introduction: Pelvic Inflammatory Disease (PID) is a polymicrobial infection of the upper genital tract characterised clinically by triad of symptoms and signs: pelvic pain, cervical motion with adnexal tenderness and fever. Conventional treatment is with broad-spectrum antibiotics. The alternative medicine, especially Homoeopathy, is the second choice of therapy as per the WHO. Case reports of PID in the medical literature are scant. We aim to report a case treated with homoeopathic constitutional medicine in a woman suffering from PID. Case Summary: A 29-year-old female presented with the symptoms of white discharge per vagina, constant dull pain in the lower abdomen, low backache, fever and lassitude for 2 weeks. Clinical findings and ultrasound of the whole abdomen suggested PID. Individualised homoeopathic medicine Calcarea carbonica was prescribed in centesimal potency which showed a positive role in the treatment of PID. Causal attribution of changes in her condition to the homoeopathic treatment was depicted by modified Naranjo criteria. Future observational studies and randomised control trials are suggested to ascertain the efficacy of homoeopathy in the cases of PID.

Keywords: Calcarea carbonica, Homoeopathy, Individualised medicine, Modified Naranjo criteria, Pelvic inflammatory disease


How to cite this article:
Pandey S, Pandit RK. Pelvic inflammatory disease treated with homoeopathic medicine Calcarea carbonica: A case Report. Indian J Res Homoeopathy 2020;14:287-92

How to cite this URL:
Pandey S, Pandit RK. Pelvic inflammatory disease treated with homoeopathic medicine Calcarea carbonica: A case Report. Indian J Res Homoeopathy [serial online] 2020 [cited 2021 Apr 11];14:287-92. Available from: https://www.ijrh.org/text.asp?2020/14/4/287/305255




  Introduction Top


Pelvic inflammatory disease (PID) is a spectrum of infection and inflammation of the upper genital tract organs, typically involving the uterus (endometrium),  Fallopian tube More Detailss, ovaries, pelvic peritoneum and surrounding structures.[1],[2] Upper reproductive tract infection is believed to be caused by bacteria that ascend from the lower reproductive tract. It is assumed that this ascension is enhanced during menstruation due to loss of endocervical barriers.[3]

The primary organisms are sexually transmitted (60%–75%) and limited approximately to  Neisseria More Details gonorrhoeae (30%), Chlamydia trachomatis (30%) and Mycoplasma hominis (10%). The secondary organisms normally found in the vagina are almost always associated sooner or later. These are  Escherichia More Details coli (30%–40%), group B Streptococcus and Staphylococcus, Bacteroides species – fragilis (20%) and bivius, Peptostreptococcus and Peptococcus.[1],[2],[4]

The incidence varies from 1% to 2% per year among sexually active women. About 85% are spontaneous infections in sexually active females of reproductive age.[1]

Some patients may be asymptomatic. The classic triad, however, is pelvic pain, cervical excitation pain and adnexal tenderness, often in the presence of fever. In severe cases, abdominal rebound tenderness may be present; vaginal discharge may be seen. Some women may have associated menorrhagia, metrorrhagia and urinary symptoms.[5]

As a system of medicine, Homoeopathy offers an effective treatment by reducing both the symptoms as well as further spread of infection. A study of 40 women between 18 and 40 years of age having infertility due to polycystic ovarian syndrome, chronic PID and endometriosis demonstrated the effectiveness of homoeopathic constitutional Similimum in the management of female infertility.[6]


  Case Report Top


Patient information

A 29-year-old female came to the Outpatient Department of Mahesh Bhattacharyya Homoeopathic Medical College and Hospital on 10th August 2019, with complaints of copious, purulent, white discharge per vagina, constant dull pain in the lower abdomen, low backache, fever and lassitude for 2 weeks. Initially, the patient had taken few doses of paracetamol for pain and fever herself with temporary relief.

She was fat, flabby and whitish complexioned in appearance. She had a history of typhoid fever during her childhood and an episode of PID a year ago which was treated with allopathic treatment. The patient was married and had two daughters. Family history was insignificant.

Generals

The patient was short tempered and anxious. Her memory and intellect were good, but it took time for her to understand things. She was lazy and did not want company. The appetite was good with desire for mutton, sour and salty++ and cold things++ (++ indicates moderate intensity of the symptom). She drank profuse quantity of water, and the tongue was moist. The patient also had a tendency of profuse sweating even on slight exertion which was not offensive in nature and did not stain the clothes. Her bowel movement was regular, and the character of stool was hard and offensive. The patient usually preferred to lie down after slight physical exertion and the sleep was sound. She was susceptible to cold and her thermal reaction was chilly. Her menses were regular, but the flow was clotted and offensive.

Clinical findings

Clinical findings were tenderness of the lower abdomen and purulent white discharge per vagina. Temperature was 99.4°F. Ultrasonography (USG) of the whole abdomen suggested PID [Figure 1]. The case fulfilled the clinical diagnosis of PID as per the Centers for Disease Control and Prevention 2015.[7]
Figure 1: Ultrasonography of the whole abdomen on 9th August 2019

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Repertorial analysis

Repertorisation was done by HOMPATH Classic M.D. Repertory Version 8.0 software (Mind Technologies, Mumbai, Maharashtra, India)[8] using Kent repertory giving priority to mental generals over physical generals and then to particular symptoms [Figure 2].
Figure 2: Repertorisation chart

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After the repertorial analysis, Sepia was found to cover 10 of 11 rubrics and scored highest marks, i.e., 27. Both Calcarea carbonica and Sulphur covered all the rubrics (11) and scored 25 marks. After consulting Homoeopathic Materia Medica, Calcarea carbonica was prescribed. The indications for prescription were fat patient with relaxed musculature, short tempered, full of anxiety, easily tired, mentally as well as physically, could not tolerate even slightest exertion, desire for salty things and cold drinks, wanted to drink lot of water, profuse sweat, tendency to catch cold easily and chilly thermal reaction.

Prescription

Two doses of Calcarea carbonica 200c were prescribed on the day of first visit along with placebo for 4 weeks. The patient was advised to maintain local hygiene.

The patient was followed for another 3 months, and no complication or relapse of the symptoms was noted during this period [Table 1].
Table 1: Follow-up and intervention

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The modified Naranjo criteria (Monarc) was used[9] for assessing causal attribution of improvement to the homoeopathic medicine and the total score was 9 [Table 2][Figure 3][Figure 4].
Table 2: Assessment by modified Naranjo criteria score

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Figure 3: Ultrasonography of the whole abdomen on 17th January 2020

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Figure 4: Ultrasonography of the whole abdomen on 16th March 2020

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  Discussion Top


PID is a clinical diagnosis implying upper genital tract infection and inflammation. Conventional treatment is with broad-spectrum antibiotics. PID is a polymicrobial infection, where two or more antibiotics may be necessary. Some patients with a severe infection need to be hospitalised to receive antibiotics intravenously. With antibiotics, acute PID may resolve within 10–14 days; however, for chronic PID, surgery is the treatment of choice.[4] In this case, a history of previous episode of PID a year back favours the diagnosis of chronic PID.

Homoeopathy is a system of medicine which treats the patient not the disease. It also aims at a rapid, gentle and permanent restoration of health.[10] As per §61, '…no physician ever effected a permanent cure of disease of considerable or of long standing unless some homoeopathic agent was accidentally a chief ingredient in his prescription'.[10]

The patient already had a history of PID a year back, treated allopathically. She was taking paracetamol for fever and pain lower abdomen intermittently for 2 weeks, without medical prescription. However, after starting Homoeopathy, she was on homoeopathic treatment alone. No recurrence was noted for 3 months after stopping the homoeopathic treatment.

Here, with the help of single constitutional medicine in a minimum dose, the patient got relieved. As mentioned in §274, 'it is wrong to attempt to employ complex means when simple means suffice' never think of giving as a remedy any but a single, simple medicinal substance.

This case report describes the effectiveness of constitutional homoeopathic treatment in a case of PID. The remedy was selected on the basis of repertorisation together with consulting Homoeopathic Materia Medica. A marked improvement of the symptoms was noted gradually in subsequent visits and marked resolution after the complete course of treatment. Monarc have been applied for the assessment of causal attribution of homoeopathic medicine, which showed the positive role of constitutional medicine in the treatment of PID in a young woman.

Appropriate constitutional and anti-miasmatic medicines, when given in proper dosage are found effective in the treatment of disease. Selection of potency, dose and repetition must be strict accordance to the guideline laid down in Organon of medicine.

As per Dr Stuart Close, in the chapter General Pathology of Homoeopathy, 'Individualization is the cardinal principle of a true pathology as well as of a true therapeutics'.[11]


  Conclusion Top


The present case report evidently suggests the successful treatment of PID and restoration of well-being of patient with the help of constitutional homoeopathic medicine. This case has highlighted the importance of holistic approach in the treatment considering the individuality of a patient for remedy selection, and not just disease symptoms. However, it would not be appropriate to generalise the usefulness of Homoeopathy in cases of PID on the basis of this single case report. Therefore, observational and randomised control trials are suggested to ascertain the result obtained in the present case report.

Consent

The written consent of the patient was obtained.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

None declared.



 
  References Top

1.
Dutta D, Konar H. DC Dutta's Textbook of Gynaecology. 6th ed. New Delhi: Jaypee Brothers; 2013. p. 127-33.  Back to cited text no. 1
    
2.
Berek Jonathan S. Berek and Novak's Gynaecology. 14th ed. Philadelphia: Lippincott Williams and Wilkins; 2007. p. 549-51.  Back to cited text no. 2
    
3.
Hoffman B, Schorge J, Bradshaw K, Halvorson L, Schaffer J, Corton M. Williams Gynaecology. 3rd ed. USA: McGraw Hill; 2016. p. 65-70.  Back to cited text no. 3
    
4.
Padubidri V, Daftary S. Howkins and Bourne Shaw's Textbook of Gynaecology. 16th ed.. Haryana, India: Elsevier; 2015. p. 177-86.  Back to cited text no. 4
    
5.
Malhotra N, Kumar P, Malhotra J, Bora N, Mittal P. Jeffcoate's Principles of Gynaecology. 8th ed. New Delhi: Jaypee Brothers Medical Publishers; 2014. p. 326.  Back to cited text no. 5
    
6.
Anita L, Prema D, Blany L. Effectiveness of homoeopathic treatment in female infertility. Reprod Med Int 2018;1:8.  Back to cited text no. 6
    
7.
Cdc.gov. Pelvic Inflammatory Disease (PID)-2015 STD Treatment Guidelines; 2020 Available from: https://www.cdc.gov/std/tg2015/pid.htm. [Last accessed on 2020 Nov 26].  Back to cited text no. 7
    
8.
Shah J. Hompath Classic M.D. Repertory Version. 8.0. Mumbai: Mind Technologies Pvt. Ltd.; 2002.  Back to cited text no. 8
    
9.
Van Haselen RA. Homeopathic clinical case reports: Development of a supplement (HOM-CASE) to the CARE clinical case reporting guideline. Complement Ther Med 2016;25:78-85.  Back to cited text no. 9
    
10.
Hahnemann S. Organon of Medicine. 5th and 6th ed. Translated by Dudgeon RE. William Boericke 26th Impression. New Delhi: B. Jain; 2010.  Back to cited text no. 10
    
11.
Close S. The Genius of Homoeopathy-Lectures and Essays on Homoeopathic Philosophy with Word Index. 6th impression. New Delhi: B. Jain Publishers (P) Ltd; 2012.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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   Abstract
  Introduction
  Case Report
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  Conclusion
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