Monday, February 27, 2012

#95 February Updates

Ok, so I caused a bit of a stir when I said that I tested for HIV and it was positive. It was NOT my test. I just ordered it. The test was for the patient in the previous blog. The one with the picture of the leg. If you haven’t seen it, glance at the picture of the leg down a couple blogs and take your best stab at a diagnosis. The real diagnosis will be at the bottom of this blog.

Some people keep abreast of James’ blog and read the story of the depressed skull fracture. Amazingly, the man is walking and talking. He’s not quite all there yet, but he’s currently able to name his wife and do other rudimentary long-term memory exercises.

Other successes lately (I know we usually just write when we’re upset, but we have successes too!)... Friday night we did two emergent OR cases. Danae might write about it, so I won’t steal her thunder. But both of those patients are doing great!

We’ve also had a couple heartbreakers. Today I lost a 14-year-old boy from respiratory failure of unknown cause. He came in last night with an O2 saturation of 76% and extremely labored breathing. He could only relax slightly if he was kneeling with his head between his knees. His lungs here chuck full of fluid. I took him to the office and did an ultrasound, praying for a pericardial or pleural effusion. I would have settled for ascites. Anything to drain! But alas, it wasn’t to be. I ordered a TB test and put him on dexamethasone, gentamicin, ampicillin, quinine and I don’t even remember what all else. This morning he was worse so I even gave Lasix a try. He eventually died. No x-rays, no lab tests, no ventilators... this case was particularly frustrating because I feel he could have lived in America if he could have ridden a vent for a few days. It was touching that the uncle came and asked me to pray for the family, as the father isn’t a Christian. He was in obvious, and expected, pain.

I have an 18-year-old girl who came in Friday. She weighs 37 pounds. She was coughing to beat the band. She’s doing better today, but her HIV test came back positive. Her mom died ten years ago, so I checked her dad. His test came back positive too. Surprisingly, for a girl who’s so obviously not thriving, her WBC were 4000 and 41% lymphocytes. We have no CD4 machine here.

Another tough case is the 15-month-old girl who’s ‘brother’ for the year is a student missionary at the airport. She has never crawled. She’s also failing to thrive, to say the least. She has been treated for malaria and has a negative test, she has clean stool. She’s taken metronidazole, amoxicillin and Bactrim for good measure. She’s received all possible worm medications. She’s just not thriving. She has a WBC of 11,000 and 57% lymphocytes. Hepatitis B negative and HIV negative. I’m wondering if she could have mononucleosis or Epstein-Barr virus. It seems like it’s probably some sort of chronic viral infection. The deck is certainly stacked against her, and it will be no small miracle for her to live.

As for the case with the pictures below. Now’s your last chance to look at the pictures and take your best shot before I tell you the answer... Ok, so in all honesty, I don’t know what it is. I can’t prove it, but I think it’s Kaposi’s sarcoma. A skin cancer common in people with AIDS. Actually, an AIDS-defining illness. I’ve never seen it localized to the leg though, and it’s possible that it’s something else. Scrofula, or ganglionic TB, is almost always in the cervical chain and would at least follow lymph nodes, which this doesn’t seem to.


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