A case of jaundice that turned out to be……………..
I remember, me and my colleague visiting a medical ward of Civil Hospital for long case viva preparation for FCPS II exam. We asked the senior registrar of that ward to guide us to a complicated case that was appropriate for long case viva. He pointed out to bed No. 10. When we went there, bed was vacant. The neighboring patient told us that the patient went to the bath room. So we waited until a young male about 20-25 years of age came out of the door and started walking in a peculiar manner. I saw his sclerae were yellow apparent from a distance. He was walking with his arms stretched, flexed at elbows with extended forearms and everted hands. His lower limbs also had hyper extended knees and somewhat everted foot. I asked the senior registrar if that patient had Wilson’s disease? He looked a bit annoyed and uttered if I had ever seen a case of Wilson’s disease? On my denial he said how could I diagnose Wilson’s disease without taking history and doing physical examination? I said of course I will examine him but the trio of being a young patient with jaundice and dystonia sparked this suspicion of Wilson’s disease on my mind!
Later when I took the history and did the physical examination, I found Kayser-Fleischer rings in his eyes with jaundice and enlarged liver on abdominal examination. Then I went through his pile up pages of file and found high urinary secretion of copper and low ceruloplasmin levels in serum confirming Wilson’s disease. The senior registrar looked so reluctant and irritated. Maybe he thought after so many days of work and investigations they made this diagnosis so he could not tolerate somebody looking at the patient and making a spot diagnosis?! It was just my suspicion and not the confirmed diagnosis that I made on my mind!
I fail to understand this behavior of our seniors and professors that they become annoyed on juniors’ correct diagnosis instead of appreciating them. I have seen and attended many presentations and meetings of clinical cases and if the correct diagnosis is made by anyone from the audience, it always irritates the presenter! I think to find and present a rare case is very good but more attention should be given to common diseases that present in atypical way!
Dr. Zeba Hisam
30th January 2019