Volume 8 Issue 4 April, 2018
It was a beautiful chilled snowy morning few years back in December. Me and my senior rushed to OPD canteen after finishing morning class and had aloo parata, makkan, cup of tea in a canteen attached to OPD building at around 9.00 am. I was supposed to clear at least 70 to 100 OPD patients usually as any other PGIans.
PGI Chandigarh being an imperial tertiary care research institute and ranked best in India; we usually get referred patients from Haryana, Punjab, J & K, UP, Bihar, other northern Indian states and Nepal.
Our first OPD patient was a fair cute thin young girl, may be in her early 10 years of age, from a remote village in Haryana. Her parents were humble, dressed in traditional Haryanvi attire and had anxious tiered look. Being first OPD patient implies that they are in our campus 1 day prior to OPD appointment and must have stood in Q from 5 am on that day to take OPD card.
Her parents told in sad helpless humble tone in beautiful Haryanvi language that her daughter is not behaving normally. I could sense from her file that they would have consulted few local hospitals, underwent many blood tests and the reason for sad anxious look on her parents face.
Further history taking revealed that her performance in school had gone down dramatically in few years and had repeated absenteeism from school. She used to stay alone in home, avoided playing with her friends and mingling with her relatives. From past few months her world is her home, her 2 little brothers and parents.
I observed that kid while talking to her parents and found she is not comfortable on her chair. I thought its may be due the presence of other patients and their care givers in same room being attended by my co-PGs. Usually 2 doctors will sit in 1 OPD room and we simultaneously see our patients.
I took her along with her parents to examination room to take detailed history and to make her comfortable. While going to room, her gait was not normal. Even while resting on bed, she was not comfortable. She frequently changed positions, picking things whichever she found nearby like bedsheet, window cover and she repeatedly poked her finger into her nose. She couldn’t establish eye contact with me, she was very anxious.
I started examining her while talking to her parents. Her vitals were fine, limited general physical examination was fine except for she was too thin for her age and her BMI was low. It was difficult to flex her limbs, all her limbs were rigid. Her respiratory, cardiovascular and abdomen systems were fine except for it was difficult to flex her limbs and all her limbs were rigid.
Thanks to my teachers, seniors, co-PGI friends and exposure to similar past patients. I could sense what I am dealing with. Immediately took my torch and examined her eyes. It looked like a KF ring, and then I called my opthal friend in next building to do a slit lamp examination for this kid. After referring, I continued to attend other patients. As expected, I received call from friend after 1 hour saying, it’s a KF ring.
We gave name of WILSONS disease with neuro-psychiatric manifestation to her plight.
We took special care of the patient as her parents were humble gentle villagers. Co-ordinated with our bosses, other departments, completed work up in few days (imaging, endoscopy, rest of necessary blood and urine tests). We started her on Triantine, Baclofen, Clonazepam, Risperidone initially but due to unaffordability Triantine which was imported from elsewhere had to be stopped and was started on Zinc. Patient recovered and recovered in few weeks.
We did screening test to her family for WILSONS disease as it’s inherited in autosomal recessive form. Luckily no one had it at that time. Pardon me for not remembering the genetic analysis report of her family. Wish and hope, she and her family is doing fine.
Dr. Yogananda M N, MD Medicine (PGI) Assistant Professor, Bowring hospital, Bengaluru (doctoryogananda@yogisclinic.in)
