A student died after medicine he was prescribed to fight Chrohn’s disease rendered his immune system unable to fight off a rare condition.
At an inquest Coroner Robert Forrest determined that Craig Adam White, 21, of Hessle Drive, Boston, died by ‘misadventure’. The Univeristy of Lincoln student died in the intensive care unit at Pilgrim Hospital on December 12, 2012, after 13 days in hospital.
Doctors were only able to confirm he was suffering from tuberculosis meningitis shortly after he died.
Dr Forrest said the immunosuppressant he had been given at hospital every eight weeks, Infliximab, meant that when he contracted the illness his body was less able to fight it.
He said doctors had been unable to detect his condition because it was so rare.
Expert witness Anne Chapman, lead clinician in infectious disease at Sheffield Teaching Hospital said only one in 50,000 people in Lincolnshire would carryTB meningitis and said people living in London and non-UK born residents were more likely to contract it.
The inquest, held at Boston Enterprise Centre on Thursday and Friday, was told Craig, who had been diagnosed with Chrohn’s at the age of 16, had previously been to two appointments at Lincoln University Health Centre and one at Liquorpond Street doctors surgery complaining of chest pains, difficulty breathing and weight loss.
He had been treated with antibiotics and had appeared to get better temporarily. Mr Forrest said this could have been due to the antibiotics fighting tuberculosis, which he said would have made it harder to spot the illness.
He also missed an appointment after getting better and another appointment for an Infliximab infusion after being too ill.
During the inquest, concerns were raised by the coroner and advocates regarding communication between doctors, hospitals and patients and it was revealed that the communication system at the time meant doctors in other surgeries had been unable to see Craig’s history.
The coroner and advocates for the family also highlighted the fact that Craig had not been regularly reminded of the dangers of his treatment by doctors.
Dr Forrest said he would be writing to the British National Formulary, the Medicines and Healthcare Regulatory Agency and the British Society of Gastroenterology to get them to make warnings over tuberculosis more prominent. He will also write to the appropriate department in the NHS which looked after IT.
Dr Forrest reiterated that Craig would probably not have died if he wasn’t having Inflaximab treatment and said that even when he first went into hospital he would have had a greater than 50 per cent chance of dying.
However, he added: “I want to emphasise that people on Inflaximab should not worry. However, if they do develop chest infections they should tell their doctors and health care practitioners that they are on Inflaximab.”
Following the inquest the family issued a statement through solicitor Charlotte Cook, from Irwin Mitchell.
It said: “Craig’s family have understandably been left devastated by their loss and have many questions about the circumstances leading to his death.
“They would like to thank the coroner for taking the time to investigate the reasons for Craig’s death and hope the inquest provides much needed answers about what happened.”