Friday, May 29, 2009

Everybody lies- House, MD.

Folks, this is an interesting piece of crap. I was posted to Anaesthesiology and intensive medicine for past two weeks. The place is full of interesting things, expensive equipment etc.. In general, almost every case admitted to ICU is an interesting case. But this one case i went through, really stunned me. I told myself, this is a house MD case!

There was a 28yrs old Malay female, who came with a 3 days history of high grade fever , productive cough and reduce consciousness. On further questioning, she also had been having night sweats, dry cough for past 3 months and losing weight. There was no other significant medical history at that time. Her temperature was 40 deg, respiratory rate was 44, pulse rate was 120bpm and BP was 80/50. She was initially treated as septicemic shock secondary to pneumonia.

Chest x-ray showed a brochopneumonia- like picture with some evidence suggestive of TB cavitations on both lung apexes. Blood and sputum culture was negative for any growth. CBC showed mild leucocytosis with predominant neurophilia. Mycoplasma antigen test was negative.

That evening a group of young women came and claimed that they are her "support group members". What support group? HIV support group! she had been with them for past 2 years. Intensivist scolded medical officer for incomplete history and the poor fella repeated it over again and got further history from the husband.

New history revealed that the patient is the second wife of the man and had been married for past 1.5 yrs. She was an alcoholic and a smoker but husband does not know if she has any risk factors of HIV such as Drug injection or sexual promiscuity (He just didnt know, but she has the whole High risk complex ie, smoking, alcohol, promiscuity, drugs). What about the husband?. He is a long distance lorry driver (we all know what it means and it’s associated risks in Malaysia). Denies any high risk behaviour.

In the dilemma, her HIV status was later confirmed by biochemical tests. Careful investigations revealed she had Pneumocystis Pneumonia (PCP) – a common opportunistic infection that occur in AIDS patients. She was then treated with Trimethoprim and her condition improved dramatically. The man refused to be rested for RVD.

But then, what would be the consequences? Did she lie to her husband about her HIV status? Or, did she get it from him? did they lie to each other? How did she manage to get married without letting him know about her HIV status if she was diagnosed 2 yrs ago? It’s easy for me to think that our job is done once the patient recovers, but definitely there would be huge social implications from this dilemma. Once again, doesn’t this sound like one of those House MD cases? It does, right?