Solomon

I walked in to the pediatric ward to start rounds and saw the nurses trying to start an IV on a new patient. Solomon is a 7 year boy who looked very ill. He was tachypneic (breathing fast), hypoxic (oxygen saturation less than 90 percent on room air), tachycardic (fast heart rate), and lethargic (not very responsive). I quickly gathered a history through a translator. The clinical officer who had admitted him had obtained from the history that he’d had bizarre behavior prior to presenting to a different health center which sent him to us. Now he was complaining of full body aches, fever, and a cough. His lungs were clear to auscultation. He complained of neck pain and had an expression of pain on his face with neck flexion and hip flexion. Aaron Jones and I did a lumbar puncture. The LP came back negative. I reevaluated Solomon and now he had abdominal pain. He had guarding and rebound on physical exam. So we discussed the case with the surgeon. Dr. Rhodes (the surgeon who’s American train but been here for 15+ years) recommended an Xray to evaluate the hypoxia even though his lungs sounded clear. (We order xrays less often here than in the states because the patient has to pay for everything we order, and so if the study isn’t going to change my management then there’s no point in ordering one). There isn’t portable oxygen at the hospital, so they quickly transferred him to the surgery building where there’s oxygen and also a portable x ray machine, because he was too unstable to go to xray without oxygen. The xray showed his upper lobe of his right lung was completely whited out. It was an odd presentation. We decided to treat it like pneumonia, and he was already on Rocephin. But it could have been atelectatis. Or the other thought was that TB usually is seen in the upper lobe of the right lung, but usually it’s a cavitary lesion and not a whited out lobe. That was late Friday afternoon, and I was off the entire weekend….. …I returned Monday morning to find him off oxygen and clinically improved. He’d been afebrile for 36 hours, sitting up at the side of the bed and looked much better! Praise the LORD 