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Turning yellow

Posted by Dr. Sushrut Jangi  October 15, 2013 04:57 PM

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This is the case of a real patient seen in a Boston hospital. After reading the case, I invite you to think through the facts and try to determine a diagnosis in the comments section below. The answer will be posted Friday.

 

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Jaundice, or the yellowing of the skin, usually first shows up in the whites of the eyes, or in the skin just underneath the tongue.

 

One winter, Jean came into the hospital emergency room with yellow skin. He had been a healthy and active 7-year-old-child. Recently, Jean had accompanied his family on a trip to their home country of Ghana. They visited relatives, ate home-cooked food, and drank local water. During their one-month stay, none of them felt anything was wrong.

Two weeks after Jean came back to the United States, he noticed his muscles had started to ache all over his body. One night, he became feverish, sweating through his clothes, his temperature rising to near 102 degrees Fahrenheit. His family brought him to his pediatrician, who discovered the child had a sore throat. Given the weeks of fever, sore throat, and body ache, the pediatrician suspected that Jean had a case of infectious mononucleosis, and started him on amoxicillin.

At first, Jean got better on the antibiotics. His fever came down and his muscle aches improved. But a couple of days later, his temperature climbed again. It had now been more than two weeks since they had returned from Ghana. Jean stopped eating; he could not bear to swallow the antibiotics. He was moaning in discomfort and felt so weak that he could not get out of bed. His family called for an ambulance and he was rushed to the hospital.

In the emergency room, his blood pressure was noted to be very low, and his heart was fluttering rapidly. The medical team started him on intravenous antibiotics. The boy drifted in and out of sleep, waking occasionally to nod his head. He was jaundiced: his skin had turned yellow. His platelets - the cells that prevent bleeding - were 10 times lower than normal.

The ER deemed him critically ill. A blood test (results shown below) confirmed his diagnosis. What was Jean's disease - and how would you treat him?

  Results on blood smear:

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Picture courtesy:

Perrine Marcenac & Dan Milner, Harvard School of Public Health

 

 

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

Sushrut Jangi is an internist at Beth Israel Deaconess Medical Center and an editorial fellow at The New England Journal of Medicine. More »

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