another scenario/presentation
 

background:
Your team is deployed to Algeria. You are running a field hospital for the local population. The following case presents itself.

• 14 yr old BM
• vitals wnl except temp of 100.5 F
• pt appears much smaller physically than the typical villager for his age
• reported malaise
• history of prior episodes similar to current
• cc of deep pain in his legs which has been prevalent since early childhood
• pt has several small ulcerations on his shins from insect bites

Visual exam reveals the following:

What are you thinking? Any questions you want to ask? Any treatments?

Hepatitis

Dengue/"Bonebreak" fever maybe

Leishmanisis

Re: another scenario/presentation
 

What does "prior episodes" mean in this case? guessing the malaise and the fever. Ulcerations not neccesarily related to this episode. The eyes look really yellow. Malaria?

Any Calabar Swellings???

Eagle

Could the yellow eyes be from liver damage due to Leishmanisis?

Then it would be cutaneous AND visceral form of the disease.

Very good guesses that are possible with the limited info given so far...

Yes, it appears he is jaundice. It can be difficult to see in the skin tone on darkly colored patients. His eyes are indeed "yellow" in appearance and are often the easiest way to pick up on it in dark colored patients.


There are no parasitic calabar swellings present. His leg ulcers appear to be from regular insect bites, but they display poor wound healing signs with secondary infection.

I may need to reemphasize that this pt's painful episodes have been "periodically" present since very early childhood up until this time.

I will throw a bone as it is difficult to Dx with these generic conditions. I wondered if anyone wanted to ask any "history" questions.
I will start...

"Has anyone in his family or living close to him had similar symptoms?"

Answer: "Yes, he had an older brother that had yellow eyes too, was very sick from early childhood. He also had severe episodes of pain in his arms and legs just like this brother. He used to have pain episodes every time he would strenuously exert himself physically. Finally, He got sick and passed away as a young teenager. "

More questions now?

Can anyone rule out the "likelihood" for any of the already given diagnosis guesses?

Is there any more information from a head to toe assessment particularly abdominal?

Or becuase this info wasnt included in the original presentation am I to assume that was also WNL?

Thanks

ccrn












Edit for clarity

I like to give minimal info, then make the Doc ask questions or request certain exams
 

Yes... there is more info available from this patient if you ask or tell me you want a specific test performed. Of course, illnesses don't read the book so not all results are "diagnostic" for the true etiology.

Since you asked, part of your head-to-toe exam did reveal Splenomegaly upon palpation.

Terminal Stages of Sickle Cell Anemia !!

? malaria

wound is an old healed bite
splenomegaly can occur
jaundice is common
malaise, muscle aches possible

high death rate if untreated.

just a guess. certainly not my specialty.

we do have a patient with ascaris on the service now....talk about disgusting...my PA pulled a worm out of the intubated patients MOUTH!

not to hijack my own thread... BUT PICS!!! PICS!!! We want pics Ma'am. LOL

back to thread....

Interesting info, thanks!

Hope you don't mind this little side post.