Medical Monday #2

S: 6month African female presented emaciated with failure to thrive.  Mother is HIV+.  Mother says baby has been losing weight regardless of normal appetite.  Patient has had a nonproductive cough for 4 weeks and fever on/off with diarrhea.  Pregnancy history and delivery unremarkable.  Mother is unsure of sick contacts and TB exposure.  Mother denies pertinent past medical diseases, surgeries, family history, allergies, or current medications. 

O:  VS: Temp: 38.4, RR: 22, HR: 92, BP: not taken, wt: 3.5 kg (birth weight 2.2 kg)
General: extreme cachexia, alert
HEENT: Normocephalic, mildly depressed fontanelles, non-injected conjunctiva, no scleral icterus, EOM grossly intact, normal pupillary reflex, CN 2-7 grossly intact.  Pharynx nonerythematous with sublingual pallor
Chest: Lungs - CTAB; Heart: RRR, no murmurs, rubs, or gallops
Abdomen: Non-tender, non-distended, no palpable masses.  Hepatosplenomegaly.
Extremities: no gross abnormalities

Labs: Malaria rapid antigen test - negative; HIV rapid test +

A/P: 1.  HIV/AIDS - given the mother's seropositivity and HIV+ test this is the most likely cause of the baby's failure to thrive.  Other causes on the differential of FTT would be social (lacking food, neglect), cardiovascular abnormalities, metabolic abnormalities, liver and kidney problems.
 - CD4, hemogramma, Cotrimoxazole prophylaxis (refer to hospital central)
2.  Failure to thrive - Patient is well below the 5th percentile in weight only 7.5 pounds at 6 months
-nutrition supplementation


Perspectives: 7.5 pound baby at 6 months old.  We dont know hunger and we dont know suffering like this.

Ghonºs complex, right middle lobe in child

Possible Kaposiºs sarcoma in HIV+ pt

Superficial infection "pioderma" seen frequently

Pt treated for Pottºs disease - TB infection of bone (lumbar region x-ray)