Rhett’s Blog

More interesting cases in Belize

Last night an interesting and complicated case came in. They called me in at about 7 pm for a 17 year old female who had vomiting and fever. I wasn’t expecting anything too complicated from that description, maybe a simple gastroenteritis, but things turned out to be different. It was a bit difficult to get to the history and find the main reason she was there. Turned out the vomiting wasn’t the most concerning thing, but the fact she had been having difficulty breathing for 4 days and cough. Dr. Sierra happened to be in the hospital at the time so he came in to help out. She sounded consolidated on the left side we decided to get a chest x-ray and CBC. In the meantime, we wanted to get more history because there were definitely some medical issues with this girl. She was 17 years old and only weighed 50 pounds! She was tiny. She had fallen on her knees three years ago and had fractured both femurs! Since that time she hadn’t been able to walk. On physical exam she had some obvious skeletal deformities. She was obviously very small in stature. She had severe scoliosis and a flail chest. The distal end of her forearms where deformed and twisted into hyperpronation. She was a bit knock kneed too. Before she broke her femurs the parents said she was normal and walking fine. In only 3 years she had become deformed and unable to walk. In addition, she had a history of nephritic syndrome about a year and a half ago. Obviously, she had had a huge lack of proper health care, most likely because of the family’s poverty. Her deformities had never been addressed by a physician and I’m pretty sure the kidney problem hadn’t been cared for properly. We did a creatinine also because of the history of renal problems. The family was poor so we were severely limited on the tests we could perform. Well, her chest x-ray was positive for left lower lobar pneumonia. To add to that her Hgb was 6.6 and hematocrit  20.5. And to make things even worse, her creatinine was 3.6. This girl was pretty sick.

                We had to get permission from the administrator to admit her as her family may not be able to pay. She was transfused and started on ceftriaxone. At this point she needs to see a specialist in nephrology, but I’m not sure what is available here in the country. I’m thinking whatever nephritic syndrome she had was not treated properly and this had progressed to chronic kidney failure. As far as the bone problems, this may be due to vitamin D deficiency or a genetic syndrome. She needs to see specialist for that too. We are treating the immediate threat of pneumonia and are otherwise very limited in what else we can do. We can’t really investigate into her problems because of the cost and this being a private hospital without a charity fund makes things quite difficult. She probably needs to go to a government sponsored institution for her other issues to get addressed where cost isn’t an issue. It’s such a sad case. I’m sure many of her problems could have been prevented with proper medical care, and now she may never walk again. Until next time. . .