[CIS-PAGID] FW: some kind of arteritis in PNG

[John Ziegler]

Dear Colleagues

Please see below an email message from a colleague who volunteers his services in New Guinea.  Madang, on the north coast, was captured by the Japanese in 1942.

No tests have been done.

John Ziegler

-----Original Message-----
From: John Whitehall [mailto:John.Whitehall at uws.edu.au]
Sent: Wednesday, 24 August 2011 10:28 AM
To: John Ziegler
Subject: RE: some kind of arteritis in PNG

Hello John,
Hope you are well. What do you think this girl has? I found the girl in Madang last year. According to the mother the hands became affected over about 2-3 days, going black. There has been no progress, nor any other issues. On examination, no other rash, lymph nodes, spleen etc. She is bright and relatively happy and is in no apparent pain. There is no family history. Mum does not appear to have HIV. I wondered if she might have been poisoned by some kind of ergot poisoning but assume it is some kind of immune arteritis. I will be interested in your opinion.

They come from a remote village and both English and Pidgin were poor. I discovered the mother and child hanging around the children's ward. They were not actually admitted but were living out the back where, I assume, there was free food etc. The child was about 2 and about 3/12 before had developed 'changes' in the hands and feet. They live about 2-3 days walk from Madang so by the time they arrived the hands and feet and isolated areas on the skin had gone black. I understand the child was never severely ill...certainly nothing to suggest collapse and peripheral ischaemia. The lesions had persisted without any change apart from progressive mummification. When I examined the child she was remarkably free of pain, was happy, eating etc and had no other physical abnormalities.

I never got the impression she had been very sick...in the manner of meningoccaemia. I think she first went to an aid post and probably received anti-malarials and chloromycetin and then she received antibiotics in Madang. There was no history of being bitten or of eating anything unusual...I wondered if there might have been some ergot containing plant...even betel nut is vasoconstrictive but surely not to that extent unless there was some remarkable predisposition.
______________________________________________________________________________________________
From: John Ziegler [j.ziegler at unsw.edu.au]
Sent: Tuesday, 23 August 2011 5:15 PM
To: John Whitehall
Subject: FW: some kind of arteritis in PNG

John

Wow, is there any more history? How old is she? I think you are saying it didn’t progress any further. Do you know the outcome (tissue-wise)?

I presume this is not meningococcaemia and that there is no history of drugs, poisonings or bites.

Could it be Kawasaki (or infantile polyarteritis)?  I preume no tests were done or are possible.

In this paper written by Mark W. the gangrene looked terrible but there was very little permanent tissue loss.
http://www.ncbi.nlm.nih.gov/pubmed?term=2450191

Best wishes

John
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