Diagnoses you never thought you'd see?

[KarafromPhilly]

What's the most unusual patient you've ever had? I've had a couple--one was a woman whose admit orders included that she was NOT to have any food from home. They suspected that her husband was POISONING her.

The other was a woman who was a former LPN with a textbook case of Munchausen's syndrome. There was really nothing wrong with her but she kept insisting (moaning, actually) that she was SO sick. Very weird.

[dirtyhippiegirl, BSN, RN]

Munchausens is a pretty common one. Leech therapy is one I thought I wouldn't see but have a few times.

We have someone on leech therapy probably once or twice a month; maggot therapy is rare, but also done.

Had a Munchhausen's by proxy. Finally dx'd after several of the kid's line cultures came back positive for organisms only found in poop.

[Nascar nurse, ASN, RN]

VATER syndrome. 1987. Had she been more much earlier they wouldn't have know what to do. 49 surgeries later, the little girl grew up to be me and I graduate in Dec w my RN! :-)

Never even heard of VATER syndrome - had to google this. Wow, good for you for coming so far. I'd say you've had a fantastic team of physicians and a whole lot of luck on your side. Congrats on graduating soon.

[Vinceq98]

Klinefelter's syndrome in a 55 year old male. Went to admit this patient and upon doing the body assessment the pt became very guarded and inquiring as to why I had to to a full assessment. He had very pronounced Gynecomastia and hypogonandism. Of course he had other comorbidities mostly psych related diagnosis. It was very sad to see and learn how he was treated (as evident in his body scars) when he was young. I can only imagine how rough his school years were during the 60s and 70s. He wouldnt let any females get near him. Only responded to males. Just made me really aware how someones surroundings can have a major impact on ones health.

[lindseylpn]

Reading this thread feels like watching an episode of House :-)

[thebusynurse]

I once cared for a pt with conversion disorder. Their admitting Dx was CVA, and they presented with R-sided paralysis, and yet there was no manifestation of a stroke in any of the tests that were done. The paralysis had no known cause.

We later learned that this pt had conversion disorder. Basically, this is a rare mental disorder where a psychological stress is converted into a physical symptom.

The pt truly felt that they were paralyzed, but they were not. With rehab, the pt could move the affected limbs if instructed to do so, and eventually overcame most (if not all) of their paralysis.

I wonder sometimes about the mind's coping mechanisms. What benefit could there be to a self-imposed paralysis? It was an interesting case.

[realnursealso/LPN, LPN]

This is what AN threads used to be like. I learned alot, unlike now when you have threads about not finding a job, how to wear your hair in nursing school, the "good popup", yada, yada, yada. I miss the old ALLNurses. I wish we could go back to learning things.

[jennilynn]

Cannabinoid hyperemesis syndrome. Pretty interesting stuff.

[sapphire18]

This is what AN threads used to be like. I learned alot, unlike now when you have threads about not finding a job, how to wear your hair in nursing school, the "good popup", yada, yada, yada. I miss the old ALLNurses. I wish we could go back to learning things.

THIS!!!^

[liveyourlife747]

I once cared for a pt with conversion disorder. Their admitting Dx was CVA, and they presented with R-sided paralysis, and yet there was no manifestation of a stroke in any of the tests that were done. The paralysis had no known cause.

We later learned that this pt had conversion disorder. Basically, this is a rare mental disorder where a psychological stress is converted into a physical symptom.

The pt truly felt that they were paralyzed, but they were not. With rehab, the pt could move the affected limbs if instructed to do so, and eventually overcame most (if not all) of their paralysis.

I wonder sometimes about the mind's coping mechanisms. What benefit could there be to a self-imposed paralysis? It was an interesting case.

My mother in law was dx with conversion disorder after a traumatic injury where she was literally bent in half from going off a slide too fast and hitting the water at the wrong angle. She's now doing fine but for almost 2 years it was a big struggle. I agree with what you said about the body's defense mechanisms. So odd.

[mariebailey, MSN, RN]

Could it not be transmitted from mother to child during childbirth? I realize STD testing is usually done during pregnancy, and if found, they do C-section. But, if not known about, or baby born unexpectedly, things like that..

Maybe I'm just being an optimist, but I would hope more cases would be from ignorance vs pedophilia...

We had this debate at work when a mother called in asking a/b how her child could have ended up with HSV2. We referred her back to her clinician, but were taught that sexual abuse should be suspected when an STD is diagnosed beyond the neonatal period. It depends on the diagnosis & the circumstances, though, I imagine. CDC - Sexual Assault and STDs - 2010 STD Treatment Guidelines

[mariebailey, MSN, RN]

Pott Disease-ended up taking 18 mos to treat

[boushie87]

I would just like to say that 90% of babies born (and most are not) living with Trisomy 13 and 18 die within 1 week, most within a few hrs. 99% die within 1 year. So it is very rare to live with these diseases and if you do most of the time you are severely disabled (in that you most likely have an IQ of around 20 and are complete care for however many years you "live".) Not nice disorders unfortunately :/