Lac caninum resolving Uvula adhesion in tonsillitis

Dr Nimai Chandra Dhole
Dr Krishna Prasanna Annapragada

Abstract: This case report describes the successful homoeopathic management of a case of acute tonsillitis with uvula adhesion in a 4-year-old female patient using Lac caninum. The patient presented with complaints of snoring for the past one month and elongated uvula deviated to left side and adhered to left tonsil on examination. After administration of Lac caninum 200C, based on the rubric “throat-adhesion-uvula-tonsil;to-left” taken from the Synthesis Repertory, the patient showed significant improvement in symptoms, with the resolution of uvula adhesion. This case report highlights the importance of considering objective symptom and reflecting its application through repertory. Photographs were taken as objective evidence after obtaining consent from the patient. The Modified Naranjo Criteria for Homeopathy (MONARCH) was used to find out the possible causal attribution of the treatment provided.

Keywords: Case report, Lac caninum, uvula attached to tonsil.

Introduction:
Tonsillitis is an infection of the palatine tonsils, which can either be due to bacterial (30%) or viral (70%) infections. Given predominance of viral infections antibiotics are known to be less effective in maximum number of cases. The commonest cause of bacterial tonsillitis is Group A beta hemolytic streptococci. Other causative bacteria include Haemophilus influenza, Streptococcus pneumonia and Staphylococci.

Signs and symptoms:

• Sore throat
• Odynophagia i.e. painful swallowing
• Dysphagia
• Earache
• Swelling of tonsils may present with or without exudate
• Peritonsillar abscess, also known as Quinsy, presents with trismus.
• Bilateral cervical lymphadenopathy

Other systemic symptoms include

1. Malaise
2. Headache
3. Fever

On the other hand, viral tonsillitis may present with milder symptoms.

Course of the disease:

Usually, tonsillitis resolves after 5-7 days but it can recur after a symptom free interval.

Complications:

Peritonsillar abscess – unilateral pain, which is severe and uvula is pushed towards the opposite side by the peritonsillar swelling.

Parapharyngeal and retropharyngeal abscesses – which are life-threatening complications of tonsillitis, presenting with non-resolving sore throat, systemic manifestations and neck stiffness along with tenderness. ⁽¹⁾

Homoeopathic approach:

Homoeopathic literature mentions the indications of medicines like Belladonna, Calcarea carb, Merc sol, Phytolacca, Calcarea carb, Lachesis, Lac can, etc in Tonsillitis. ^(2,3)

Homoeopathic repertories also represented the rubrics related to Tonsillitis, which is helpful in the quick selection of remedies. For example,

1. Kent’s Repertory: ⁽²⁾

• Throat Internal – PAIN – Tonsils – Alum.am-c. Benz-ac. calc-p. Caust. crot-t. graph. Hep. kali-bi. kali-p. lach. Merc-i-f. naja raph. Tarent
• Throat Internal – Swelling – Tonsils – Acon. alumn. alum. Am-c. ant-t. Apis arum-t.Aur. BAPT. BAR-C.BAR-M. BELL. berb. brom. Bufo CALC. Calc p.Calc-s.canth. Carb-ac. carbn-s. cedr. CHAM. Chel. coc-c. Colch. cop. Crot-t. Dulc. fago. ferr-p. Fl. ac. Gels. Graph. Guaj. guare. ham. HEP. hippoz. ign. Iod. Kali bi. kali-c. Kali-chl. Kali-i. kali-p. kali-s. LAC-C. LACH. led. LYC. Manc. Merc. Merc-c. Merc-cy. Merc-i-f. Merc-i-r. Mur ac. nat-act. nat-s. nicc. NIT-AC. nux-v. PHOS. PHYT. plat. Plb. puls. Ran-s. raph. Sabad. sep. SIL. sol-ni. stann. Staph. SULPH. tarent. tep. thuj. verat. Zinc

2. Murphy’s repertory: ⁽²⁾

Throat – Tonsillitis, infection, tonsils – Acon.aesc. Ail. ALUMN. aml-ns. anan. ant-t. anthraci. Apis Ars. bad. Bapt. BAR-C. Bar-m. BELL. benz-ac. berb.  Bufo Canth. Caps. cedr. Cham. chel. Chen-a. Colch. Crot h. Cupr. cur. Dulc. ferr-p. Fl-ac. Gels. GUAJ. ham. HEP. Ign. Iod. Kali-bi. Kali-chl. kali-p. LAC C. LACH. Lyc. MERC. Merc-cy. MERC-D. Merc-i-f. naja Nat-s. NIT-AC. Phyt. Plb. Psor. puls. Sabad. Sang. sep. SIL. Staph. Sulph. tarent. ust. verat. vesp. Zinc.

3. Boger Boenninghausen’s Characteristic materia medica and repertory: ⁽²⁾

Mouth – Throat (and gullet) – inflamed – tonsils – ACON. alum. AM-C. Apisarg-n. Arn. arum-t. aur. Bapt. barc. BELL. brom. calc. CANTH. caps. CHAM. colch. crot-h. Dulc. Ferr-p. gels. Guaj. HEP. IGN. iod. kali-i. LACH.LYC. Mang. MERC. Merc-c.Merc-i-r. mez. NIT-AC.NUX-V. PHOS. Phyt. plb. PULS. sang. sep. STAPH. sulph. thuj.

Case report:
A 4-year-old Hindu female child visited the OPD (on 11 March 2024) of JIMS Homoeopathic Medical College and Hospital, Telangana, India, with the complaints of Snoring and recurrent cold and cough with throat pain for the past 7 months. The primary informant was child’s grandmother. As per her narration, complaints were triggered on exposure to cold air, however the child desires cold things. Symptoms usually start on one side, as they start reducing, the other side is affected.

There is no significant past history and family history.

On the day of visit, examination revealed bilateral turbinate hypertrophy, white coated tongue, swollen tonsils and congestion of throat. Elongated uvula which is deviated to left side and adhered to the left tonsil was also noted.

Timeline including follow-up:

Sno	Date of visit	Signs and symptoms	Prescription
1	11/3/2024	Snoring Cold and cough  Throat pain Tonsils swollen & Uvula elongated, deviated to left side and attached to left tonsil.	Lac caninum 200/3 doses Review after 7 days
2	18/03/2024	Snoring – SQ Cold and cough – reduced slightly (40%) Throat pain – reduced slightly (50%) Tonsils – swelling reduced (70%) & Uvula – elongated, deviated to the left side with adhesion to left tonsil.	Placebo – 3 times a day for 14 days
3	3/4/2024	Snoring – reduced completely Cough reduced (80%) & Cold – reduced slightly (60%) Throat pain – reduced completely Tonsils – swelling reduced (70%) & Uvula – placed centrally, no deviation and adhesion to left tonsil is resolved.	Placebo – 3 times a day for 14 days
4	22/04/2024	Complaints – relieved No new complaints	Placebo – 2 times a day for 21 days
5	13/05/2024	No new complaints. No recurrence of old complaints	Placebo – 2 times a day for 42 days.
6	20/06/2024	No new complaints. No recurrence of old complaints.	Placebo – Once a day for 42 days.
7	26/08/2024	Review after 1 month – 7 days since the child was apparently healthy and there were no episodes of Tonsillitis. O/E. Oral cavity and throat appeared normal. No signs of Tonisllar hypertrophy, Uvula centrally placed and no congestion.

Analysis of case:
The rubric “throat-adhesion-uvula-tonsil;to-left” is selected as a base for prescription in this case from Synthesis Repertory, version 2.0 of RADAR software (Fig. 01).

On repertorisation, a single remedy Lac caninum was given for the selected rubric. Upon consulting Materia Medica, Lac caninum 200 C – 3 doses were prescribed on the first visit and the patient was told to review after 7 days.

Discussion:
The case mentioned above throws light upon the utility of objective symptom in prescribing through repertory. In this case, Lac caninum was prescribed as it is a single remedy for the rubric “throat-adhesion-uvula-tonsil;to-left”, given in Synthesis repertory, showed in Figure.01.The application of Lac caninum in the above case is also verified with the consultation of Materia Medica, which mentioned the use of the remedy in Tonsillitis, where the symptoms change from side to side along with pain in throat. ⁽⁴⁾ Modified Naranjo Criteria for Homeopathy (MONARCH) was used to find out the possible causal attribution of the treatment provided and Table.01 shows the grading of MONARCH criteria.

Conclusion:
The present case report shows the role of Homoeopathy in treating Tonsillitis where Lac caninum was prescribed on repertorial basis, where the objective symptom is solely taken for the purpose of repertorization. The case showed evident positive results. MONARCH criteria showed a score of 7, reflecting a probable causal attribution between Lac caninum and tonsillitis.

Patient perspective: Primary informant narrated the improvement in complaints before and after the treatment. The testimonial is taken in the form of video (mp4.)

Declaration of patient’s consent: Consent from the parents is taken, as the age of child is 6 years. Child’s parents have given their consent for her photographs and other clinical information to be reported in the journal. They were made to understand that child’s name and initials will not be published and due efforts will be made to conceal her identity.

Acknowledgement:
We express our sincere gratitude PGs – Department of Practice of Medicine (2021-22), JIMS Homoeopathic Medical College and Hospital for your support.

References 

1. Yao A, Cameron M, Mclntyre C, Allen J, Raja MK, Doshi J, et al. Ear, Nose and Throat: The Official Handbook for Medical Students and Junior Doctors. 1st edition. UK: ENT UK; 2019.
2. Sreevidhya JS. Tonsillitis and Homoeopathy: Review Article. International journal of science and healthcare research. 2023 Aug 31;8(3):166–9.
3. Senthilkumar DJ, Dr. Blessy Chacko. Tonsillitis and homeopathic management. International journal of homoeopathic sciences. 2020 Jul 1;4(3):28–32.
4. Boericke W. New manual of homoeopathic materia medica and repertory. New Delhi: Kuldeep Jain For B. Jain Publishers; 2003.
5. Schroyens F. Synthesis Repertory 2.0 [Internet]. Zeus Soft sprl; 2009. Available from: www.radaropus.com
6. Perkins DC. A Study of Lac-Caninum. Homoeopath Physician. 1891 Feb;11(2):84-88. PMID: 37136144; PMCID: PMC9717928.(Article)

Corresponding Author:
Dr Nimai Chandra Dhole, MD (Hom.)
Principal & HOD, Practice of Medicine, JIMS Homoeopathic Medical college and hospital, Hyderabad.
Co-Author: Dr Krishna Prasanna Annapragada MD (Hom.)
Medical Officer, JIMS Hospital, Muchintal, Hyderabad.
Email: drnimaichandradhole@gmail.com

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