Interesting cases

Some of this will probably only be interesting to health care workers. First, an update on my little malnourished baby. She is thriving. She has been in the hospital close to a month now. She has gained almost half of her original body weight. She started at just under 7 pounds and now is just over 10 pounds. She is very close to her target weight so she may make it home for her first birthday in just over a week. She is my bud. She always lets me hold her and yesterday she even gave me a little smile. I brought my colleagues from the clinic over yesterday who were shocked at the change. Mom was beaming. I will try to get a picture to post soon. She is still very developmentally delayed (not even able to sit up on her own), but hopefully by her second birthday she will have caught up!

About one month ago a new patient walked in who had swollen lymph nodes in his neck, armpits and groin. His chest x-ray also seemed to have lymphadenopathy. His CD4 count is just over 200 (low, but not horrible, horrible). The two things I was worried about were TB and lymphoma. The surgeon did not want to do a biopsy under anesthesia because of his cough so I started TB medicines. He came back last week after a month with worsening of his previous lymph nodes and new masses. His fevers and sweats are better though. Some of the new lesions are not in typical spots for lymph nodes, which is somewhat perplexing. This time I was able to convince the surgeon to take one out to look at the pathology. Hopefully, that will give us an answer.

Below is a new diagnosis 8year old with a very, very low CD4 (31, I think) who has Kaposi Sarcoma on his left leg. Kaposi Sarcoma is a rare cancer. There is a form that is endemic to Africa and then a form that occurs in HIV patients with severe immune compromise. His disease is localized so it may respond to the antiretrovirals for HIV alone. If it is more extensive or systemic then chemotherapy is used. Unfortunately, Swaziland is right now out of the KS chemotherapy.

Yesterday I saw a 28 year old nursing student who had initiated on ARVs three months ago. Since iniation she had lost 6 kg (around 15 lbs). She did not look good when she walked in, but only complained of weakness and was febrile yesterday, but denied previous fevers. She denied cough, but on exam had some crackles in her lungs so I got the below x-ray. The picture did not turn out great. The x-ray is classic miliary TB. This is a less common manifestation of TB caused by spreading through the blood stream. It is more common in young infants or again the severely immune compromised. This was my first time diagnosing it. I again pressed the patient about fevers, sweating, coughing, but she again denied it all. I think she may be in denial as she does nto want to have to miss school. Unfortunately, I think she will need to for a few weeks at least. Joyce, our medical director, said at her former hospital in Swaziland they would lose a few nursing students every year to HIV.

Everyday in clinic we see amazing gogo (grandmother) after amazing gogo. They are doing their best to raise these children to be healthy. Unfortunately, as they get older and ill themselves we sometimes encounter problems in finding someone willing to assume care for these children. This is a case with a couple of brothers (who would be cousins in our culture) that we have been seeing regularly. Through a home visit, we hopefully have come up with a plan for their future.

Finally, a little girl who I first me about a year ago in the hospital. She has neurologic damage following cryptococcal meningitis. Mother has been carrying her (55 lbs) on her back since last year. Just before I came back to the states we arranged for mom to go to a local charity that provides rehabilitation. Through this organization they were able to get her a wheelchair. Both mom and daughter had smiles on their faces that day. GG was even dancing for us.