unusual cases

As far as I can tell, the three most common (serious) presentations in internal medicine in Canada are myocardial infarction, lung/breast/prostate/colorectal cancer, and COPD. In Lusaka, things are a little different. I get the feeling that the internist's bread-and-butter here is TB pulmonary infection with HIV co-infection. A few of the random things I have seen I list below:

1) Cryptococcal meningitis - fungal infection of the brain that only occurs when cD4 counts drops to a certain level in the presnce of HIV
2) Miliary TB - a pattern of TB on the X-ray that looks like little nodules (millet seeds) everywhere in the chest
3) MDR TB - we went to see a patient, and before I realized it we were in the TB room. Everyone just walked in, no masks or anything. After I left, my doctor told me the patient didn't just have regular TB, but MDR TB. So much about immediate respiratory isolation when TB is suspected!
4) Chloramphenicol - a cheap, powerful antibiotic that isn't used in Canada since it causes aplastic anemia but that is quite common here
5) Peripartum dilated cardiomyopathy - we didn't ever learn about this in class... it is a variant of dilated cardiomyopathy found in pregnant / post-partum women - usually reversible, but can present with cardiogenic shock

There are also quite a few cases of hypertension and diabetes, which I found surprising. Interestingly, it seem that the hypertension here tends to cause heart failure, as opposed to MI, most often...