A few interesting patients from the men's ward

Usmanu came in with a 3 year history of progressive distention of his belly. His old records showed that an ultrasound several years ago showed a big liver. We repeated this and found that he now had a shrunken liver and a huge amount of ascites (fluid in the abdominal cavity). His test for hepatitis B antigen was positive. He was negative for HIV.

 .......So, this poor man has chronic infection with hepatitis B which has led to cirrhosis of his liver which is now weaping fluid into his abdomen. We drained off some fluid and hope that diuretics will keep the fluid from accumulating quickly. His liver disease is not reversible and he is at risk of developing liver cancer.
....The statistics of hepatitis B are staggering. About 400 million people worldwide are chronic carriers and each year, about 1 million die from advanced cirrhosis or liver cancer. Thankfully, in the US, children are now vaccinated for hepatitis B and many adults, especially healthcare workers, have also been vaccinated. In developing countries, cost and lack of good infrastructure limit the number who are immunized.

                                                                             This young man was in the hospital for nearly 6 weeks. He had had a "dirty" wound several weeks prior and came in with marked stiffness of his muscles, and confusion. His exam was typical for tetanus - he had "lock jaw" to the point where we could not pry his jaws open. A spinal tap showed that he also had meningitis with a fungus called cryptococcus - usually seen only in people whose immune systems are very depressed eg HIV. Fortunately, his HIV test was negative but, due to our concern, he will be going for a more specialized HIV test after his discharge. We treated the tetanus with tetanus antitoxin, muscle relaxants, and antibiotics. He gradually improved..

Julius is a 30 year old man with known HIV who had not been faithfully taking his ARV (antiretroviral meds). He came in with significant shortness of breath and black lesions all over his body. The picture shows characteristic lesions of Kaposi's Sarcoma, a cancer commonly seen in patients with HIV. His chest X Ray (see below) shows widespread abnormalities in both lungs. With advanced HIV, patients are susceptible to what are called "opportunistic infections" - infections that usually don't cause trouble in people whose immune system is normal. We wondered about a pneumonia called "pneumocystis" or "PCP" as well as TB and even bacterial pneumonias. Since we don't have tests for all of these possibilities, we started regular antibiotics as well as high dose Bactrim for PCP. His sputum did not return showing any TB. After a few days of treatment, his breathing was much easier and he no longer needed oxygen. After his pneumonia is more fully treated, he will receive chemotherapy for his Kaposi's sarcoma.