Monday, April 21, 2014

An unusual presentation

JO was a 15 year old jovial boy who suddenly took up sick with fever about a month back. He was sick for almost 2 weeks and was treated successfully elsewhere. After discharge, JO’s father noticed that his son was not his former self. He suspected something was wrong.

His suspicion turned out to be true within a couple of days, when JO became unconscious gradually. Even his family did not take the way he became unconscious seriously as it looked more of JO becoming more and more sleepy over the day.

When JO was wheeled into our Acute Care, he was hardly breathing. JO had something very bad in his brain. He was running a high fever and had anisocoria. We had to do a CT Scan. But, JO was hardly breathing on his own.

After almost 2 days of mechanical ventilation, we could wean out JO from the ventilator. Considering the sort of diagnoses that a young boy with anisocoria can have, we were anxious for the CT Scan Brain. With a backup for ventilation, we rushed him to the nearest town for the CT Scan.

The CT Scan showed a hypodense area in the periventricular white matter of the right temporal region.

After he returned, the anisocoria stayed. However, a fundoscopy did not show any features of a raised Intracranial Tension. With a guarded prognosis, we took a decision for a lumbar puncture. The family readily agreed . . . in fact, we had not given them even a day for their JO to survive.

Lumbar puncture was suggestive of a partially treated bacterial meningitis with a higher protein levels than usual. Considering the long history of the illness, we took a decision to come to a diagnosis of Tuberculous Meningitis.

JO has responded well to anti-tuberculosis treatment. However, he’s yet to be completed fit for discharge.

We’re blessed to be a blessing in the life of JO and his family. Kindly pray that this young boy will be completely healed. 


  1. Hi Jeevan,

    Thank you for your blog, it is quite interesting and insightful and I appreciate your dedication to educating us through your posts. I am a student at Tulane University School of Public Health studying Maternal and Child Health. We study an array of topics, including clinical and cultural aspects of reproductive health. I am currently doing a project on abortion in India and have found this blog useful to my understanding of the subject.

    I do have a couple questions for you or anyone else that may see this comment...please feel free to post a response. I'd love to hear from anyone.

    1) What has been your experience working with women in India that have had abortions, and specifically, sex-selective abortions?

    2) In your opinion, what are the implications of sex selective abortion on woman's health (both physically, emotionally) and their effects on the woman's role in society?

    3) The government of India has passed laws banning sex-selective abortions, but there is evidence this is not necessarily working in the current system. What do you think the government could do that they are not currently doing (or that they are doing but could do better) to empower women in this regard and protect their reproductive/human rights?

    4) How do you think society perpetuates the practice of sex selective abortion and what do you think needs to be done to begin to shift the paradigm?