I just had my first patient [for this school year] today! *I toned down the jargons and made the text a bit lighter*
Ward 3 Bed 39
O.G. is a 56-year old male, married, right-handed, Roman Catholic from Samar. He was diagnosed with diabetes melitus in 2002. He used to plant abaca for a living! OG has a chief complaint of an enlarged scrotum (hydrocoele) with associated tenderness and swelling in the proximal areas of the inguinal and inferior gluteal area.
The swelling began early this month as a marble-sized mass in the inguinal area. The patient was also febrile at that time - the exact temperature was not recorded. It brought significant pain as it it eventually grew larger. A few days later, swelling was observed in the patient’s scrotum and his wife decided to bring him to a hospital. The growing mass popped and out came blood, pus and foul-smelling stuff!
Jackpot. One of the most straight-forward diagnoses known to man (and woman). Primary impression after the jump!
The patient presents this way:
Filariasis - Most of us (if not all) knew that it was going to be the diagnosis a few seconds into the interview.
Yes. Your eyes didn’t deceive you. If you watched the Magandang Gabi Bayan features of yore about this disease, you would know that this is endemic in the Bicol region along with a few islands in the Visayas. For some reason, abaca has been implicated as one of the possible breeding sites of the parasite that causes this gruesome morbidity. The pathogenesis is also responsible for elephantiasis where in the leg/s become similar to a pachyderm’s extremities.
How did it happen?
Mosquito bites. I’m not kidding. But it’s not the bite that makes your scrotum/leg swell like crazy - it’s the worms that the mosquito leaves behind inside your body. When these worms reach adulthood, they tend to aggregate in the lympathic vessels and if you’re really unlucky, you can end having those vessels obstructed. When chyle (the lymphatic fluid + chylomicrons) can’t drain, it accumulates and makes things swell and well… huge.
For all you know, you might have these worms inside you but due to fact that they haven’t reached adulthood yet, the OBVIOUS physical manifestations may still be sub-clinical! It could takes years before symptoms arise…
Are there any tests to check if you have them anything short of seeing them in one of your lymphatic vessels? NONE. Wahahaha. Food for thought! :p
Can it be treated?
Of course. We just have to scoop out the dead tissue, pus and foul-smelling gross stuff plus a nice treatment course of diethylcarbamazine should do the trick. If you’ve had your foot totaled, it won’t going back to normal, sorry. Your balls will be fine though.
Note: The photo above is not the patient’s! I still have a sense of ethics, you know. haha.
Apparently, it wasn’t a filariasis case. Just like Gregory House, my first hunch was wrong. Cut me some slack here! It takes House 3-4 mistakes before he finally figures out what’s wrong with the patient. The official diagnosis is FOURNIER’S GANGRENE. It has nothing to do with filariasis and worms but it’s still umm… gross.
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Poor guy we have here. How can you expect these patients to live a normal life?
Keep us updated about his recovery. Is he going to undergo an operation in the coming days?
Maybe Bicolanos especially abaca farmers should be careful.
Maybe they should carry a katol around
This entry is a bit Dr House! ♥ Except no drama involved in the diagnosis.
Haha! I agree with Helga. Dr. House is in the… house? LOL. Yeah, ang corny. Hehe. Anyway, the idea of worms growing inside you is one monumentally gross! Good luck with the patient.
Question, may makikita rin kayong worms na lumalabas dun sa growing mass?
ummm, auto-immune at vicodin lang alam ko sa house. wehehe
Well that was…ergh, I don’t know what to say. I don’t think I could take actually seeing someone have body parts bursting/being operated on. *shudder* Even the autopsy scenes in CSI makes me cringe; what more if live? That’s a reason why I did not take a Med related course in college.
I do hope your patient gets well.
And just when I thought my balls are the largest.
I think I’ve seen that Magandang Gabi Bayan presentation before, but I was..err, too young then, I guess.
Anyway, I had a little headache understanding the medical terms! LOL. But I got the picture of the disease. Too bad then for the abaca farmer(planter?). Could have been careful with the mosquitos. And he’s gonna be treated by you, right?
back in the school groove i see. worst nightmares all over the place.
eew! haha! and men thought big balls were the solution to the world’s problems!
How big was the mass when you saw it?
That is one interesting case. I pity him because of the suffering he has to endure because of it. It also makes me wonder how some people could have waited a month with a problem like this before consulting a physician while some other people would quickly go to the emergency room with only a temperature of 37.0 degrees Celsius (it’s not even a fever! they only deem it as fever or “sinat” because “it felt like it”) and some slight cold. And note, magagalit pa ‘yun when you don’t see them immediately because as an ER physician you were busy with ER cases. And common pa nilang reason why they should be seen first is they came in first! Duh.
Doc, what happens to all that skin? how can testicle skin stretch that much and what will happen to the skin after you “scoop out all the gross stuff”?
I don’t know half the words you used! Haha. Poor guy. But at least he’s getting treated. Nakita ko sa TV before yung ibang may ganung sakit, napapabayaan na lang kasi they can’t afford to go to hospitals.
ang scary naman nito. i’d rather die than have this.
hope you had a great time scooping out all that gross stuff.
That is so frigging gross.
Sayang…I’ve never seen an actual filariasis patient. I haven’t really seen rare cases, except perhaps for rhabdomyosarcoma, stroke in the young (as young as 3 years old), and Takayasu’s arteritis. You would have been lucky to see these cases in your lifetime, although I wouldn’t be too sure about the statistics of those cases in your hospital.
grabe, sometimes i really want to be a doctor and know those stuff. lolz. but i love history more than science so.. whatever.
gangrene! oh i love the word.
Tell us more about FOURNIER’S GANGRENE. Hmmm.. sige na hehe
[...] essentially a flesh-eating infection. It’s a lot worse than my filariasis hunch. Bookmark at:StumbleUpon | Digg | Del.icio.us | Dzone | Newsvine | Spurl | Simpy | Furl | [...]
That’s why I chose to do programming: it’s less complicated.
I’ve only gone so far as make a HUGE scrotum for our health teaching, but I never saw one with balls that huge. Need. to. see. one. now. lol