Our case this week is something a little bit different! One Friday afternoon as we were preparing to leave the hospital for the weekend we heard that there was an emergency in the outpatient department. So before we got in the car we went to see what was going on.
The patient was a man in his mid-twenties and he was behaving very strangely, not answering questions appropriately and appearing quite confused. He also seemed to be in severe pain from his left hand and arm. The relatives and outpatient doctors kept referring to a wound on his hand, however when we looked we only saw a very small scratch between his thumb and index finger. This alone did not seem to explain his symptoms. Some further information was then revealed by the relatives - the scratch was from a poisonous fish found in the waters around Zanzibar. At around the same time the patient started to develop very strong muscle spasms causing him to almost fall from the bed.
He had already been treated in outpatients with IV fluids and anti-tetanus injection, so we gave him some treatment to reduce the muscle spasms while we tried to make a further plan. With the help of Google images we managed to identify the fish as a stonefish, one of the most venomous fish known. Unfortunately, there is no specific treatment and all management is supportive.
He was admitted to the ward for observation and also received the antibiotic treatment for tetanus, as some of his symptoms were also consistent with that. The next day we contacted the on call doctor who told us that he was improving. We also researched a bit more about the stonefish and heard that many times a sting can even be fatal, so this young man was lucky.
This is an example of some of the very different and unusual presentations we get here in Zanzibar compared to what we are used to in Europe!