Sunday, June 10, 2012

At Hospital CEML

Dermatology is not my strength, so skin diseases continue to keep me humble. I read in one manual that skin diseases make up 20% of outpatient visits in the developing world. That’s more than I see, but there isn’t a day that goes by without at least one patient with concerns regarding the body’s biggest organ. Here are three of many patients I have seen. . . .

This is a young lady who had lived further in the interior of the country for a couple years and came because she was having an itchy rash all over her body (except her head). These lesions were tight and were not fluid-filled.
She had a slide of her blood prepared and reported to have microfilaria whipping around. Diagnosis: Loiasis. Since we don’t have the first line treatment, DEC, available, the royal we prescribed a 3-week course of albendazole. She hasn’t returned, so we hope it worked.

This 45-year-old gentleman has a rash I’ve seen several people with. It started on his shins 10 years ago and gradually has spread up. He had a (successful?) ligature of his veins on the right leg that stopped the spread, but had an unsuccessful attempt on this left leg. He also went a 6-month treatment course for pulmonary TB but this rash continued to spread during that time. He is in the hospital for a skin graft of a part of the rash that had ulcerated; he was treating that area with cow dung—to no avail. He had a couple checks for lymphatic filariasis that were negative (and he’s HIV and VDRL non-reactive, too). Diagnosis: not sure, and we welcome your thoughts! Being a surgical hospital, his skin grafting will be prioritized.

The right leg (like his other side) had a saphenous vein ligation.

We frequently find this strange boy waddling around in our kitchen, getting his hands, feet and face into anything he can find. The lesions on his face tested positive for chocolate. Diagnosis: bagun├ža