5 interesting cases...

Another long day with about 40 patients keeping me busy from 8am till 630pm of which 5 were quite interesting/memorable and I should be seeing again. Let me introduce you…

First of all there was 2 year old Hussanatu who had been sick with diarrhea and vomiting for 4 days. She went to a hospital 2 days ago but staff couldn’t get an iv line started so the mother took the child back home. When she showed up at the clinic it was a shock that she was so dehydrated. We got to work right away to start rehydrating. 4 hours and 800 ml of ORS later and she looked much better and even wanted to play with my toys. I hope to see her in the morning!

Second there was Sulaiman, 2 years old, who looked fairly okay except that he was very pale. Sure enough he had an Hb of 5.5 g/dL! Unfortunately I could not find the cause as multiple malaria tests were negative and he has not previously had this problem. Worms? Nutritional? Hemolytic disease? Seeing as he was stable I am treating him as outpatient with antibiotics and iron and folic acid and will see him again tomorrow when he returns with his results (blood film and sickle cell test). We’ll see how this unfolds!

The strangest case was a very playful 1 year old who made me wonder why he came. His mother proceeded to give a somewhat bizarre history of him having seizures everyday for the past year. Nothing quite added up. I wasn’t sure if I should believe it. Well, to my surprise, while in the lab later, he had a very short seizure-like-episode so I did refer him for further assessment. Interesting!

Most interesting was a 7 year old boy who lives upcountry and pain/difficulty urinating for 2 years! He has been to various hospitals upcountry, been admitted, been transfused, given country medicine. Of course, no diagnosis was ever made. When I asked him to pass urine to collect a sample he did so, but was in obvious pain; poor little guy. The long history was bizarre and I was hoping for some clarification through the lab. Fortunately his results pointed towards infection.First of all he had malaria which explained his large spleen. Second of all his urine showed many signs of infection: blood, leukocytes, nitrite. So, he is on antimalarials and antibiotics and I’ll see him again on Friday. I pray this problem clears up after 2 years. If not, maybe we are looking at a more complicated urinary tract problem!

My most adorable but also most worrying patient is a 1 year 2 month old girl weighing only 4.6kg; sweet but too small. Her father died just before she was born and her mother left her to the granny and aunty when she was only 5 months old! Now she is not thriving. Her weight for age is at the bottom of the chart. Her mid upper arm circumference is tiny, probably the smallest I have measured yet. So, I have referred her to the therapeutic feeding center and they’ll have to check for HIV, TB etc. However, the social situation is complex, so I will actually see the whole family in the morning to discuss admission with them. Hopefully I can convince them…