This post has no redeeming value but is just an example of the challenges of diagnosing things here in the Republic of Congo.
Last week we received a 5 yo in a coma. He had a fever for several days, had been seen at another medical facility and started on quinine for malaria. 2 days before he came in he developed a huge mass in his abdomen and his parents brought him to us to see if there was something we could do. He also had developed seizures as well.
When we originally saw him he responded only a little to pain, had a fever but had no other signs of meningitis. He did have a mass in his abdomen that moved pretty easily. He was anemic (hematocrit of 27) on his blood work but other values were ok. I did a spinal tap which was normal as well. We performed an US and found out the mass was actually a huge bladder that went up to his belly button. We placed a urinary catheter and got an urine sample. He had an urinary tract infection. We continued antimalarial treatment and started antibiotics for urinary tract infection.
Our initial thoughts is that he had a partially treated form of cerebral malaria and a secondary urinary tract infection and that with treatment for the malaria he would wake up.
2 days later he did not wake up.
Below are three pictures that should help with the diagnosis (tentative) that we made
Big sluggish eyes bilaterally.
Chart showing fever curve, without a lot of sweating.
shows the urinary retention
So what do you think? If you care to respond just leave a comment