Help determine differential diagnosis for further treatment

fd case full

Our partner, Floating Doctors, posted a patient case this morning needing immediate insights from our SERMO physicians.

Three months ago, physicians in the field treated the patient.  Based on history and past medical intervention, physicians initially suspected TB (endemic in the region though not in her other family members at present) and sent her to a distant hospital to be checked.  The hospital did a chest x-ray which they told her father was negative for TB.  The father reported that her condition had been exactly the same since then; the hospital let them go without any further follow-up after telling them she was negative for TB.

Floating Doctors volunteers gave her albendazole once daily for three days, repeated in two weeks, and ivermectin orally as a single dose repeated after one week.  They nebulized her with an ipratoprium bromide/salbutamol combination to see if it would produce any noticable improvement; it produced a modest improvement in lung sounds and she felt better.  They trialed her on a betamethasone inhaler twice daily, and a salbutamol inhaler PRN up to twice a day and decided to submit her case to SERMO before their next opportunity to intervene.  This visit is coming up soon and they want to be prepared.  The Peace Corps worker in that community tells us that the girl is generally the same although the inhalers have helped.

In order for Floating Doctors physicians to get the best plan possible ready, they need insights on next steps from SERMO physicians.  Cost is a factor, as they will have to raise funds do at least some of the investigations in the private health care system in the nearest large city, so prioritization of investigations is important to get the most bang for their buck. For example, a CT scan costs about $550–more than half their entire monthly budget for assisting patients with travel to distant services and health care cost subsidies. Normally amount would sort out 8-10 of their patients that need referral assistance.

DIFFERENTIAL OPTIONS TO CONSIDER:

  • Tuberculosis
  • Asthma
  • Tropical Eosinophilia
  • Allergic alveolitis
  • Parasitosis
  • Pulmonary Fibrosis

If you are a physician, please log in to read the full case history and help consult on this patient case.

 

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