As I was finishing rounding today in room B, a shy and sad appearing mom approached and asked, “Can you please help me? My baby is sick.”
In her arms was a small child, appearing to be a bit under a year-old with big, round eyes. She was alert and in no distress but her skin had the look of chronic malnutrition. She had swelling on the sides of her face and she was coughing frequently. I had an idea what she had but needed to explore a bit more.
I directed the mother to a bench in the back of the ward. As she slowly walked over, I noticed a man behind her carrying another child, this one about the same size. The four of them sat close to one another.
As I pulled up a chair, I questioned, “Is this her sibling?”
The mother replied “Yes, but she is not sick.”
“Are they twins?” I asked
“Yes, this one (the sick one) was born first. She (the healthy one) was born second. That was nine months ago.”
Huh, I thought to myself. There was now a crack in my theory. I was thinking my patient potentially had a chronic illness such as HIV and/or tuberculosis. But this sick patient was the same size and same developmental level as her healthy twin. Something seemed odd.
As I asked more questions, I discovered my new patient had frequent fevers, a prolonged cough and weight loss. On exam, she had an obvious pneumonia. This led me back to my original line of thinking.
I sent her for an x-ray……30 minutes later I saw an image classic for tuberculosis. Then I took her to the lab. Within five minutes, I got results….positive for HIV.
I sat for a bit and scratched my head. Then I decided to get help from another doctor.
I approached Patrick, the director of the Family Practice residency. I said, “I’ve got this set of twins that are the same size and developmentally equal. One has HIV and TB and the other seems healthy. Can you talk with them and see if I missed anything in the history? Something seems odd.”
After a few minutes, Patrick pulled me aside outside of his office. With a slight smile, he said, “Good job with the TB and HIV diagnosis. But they are not twins. The sick child is three years-old and the healthy child is nine months-old.”
Then, as if he could see the self-doubt in my face, Patrick said, “Well, when I first saw them, I thought they were twins too.”
I sent the family home and gave them money for a taxi to return in the morning. This time I will have an interpreter and then run tests on everyone.