First of all, the diagnosis seems clear to the Nigerian doctors: the young patient, who suffers from severe sweating and headaches, must have malaria. Ten-year-olds repeatedly plague the symptoms for several months. She has no appetite and is getting thinner and thinner.
About a year goes by, when the child is repeatedly treated in a clinic as a malaria patient, without improving his condition. Finally, the doctors transfer the girl to the teaching hospital in Ido-Ekiti in southwestern Nigeria.
There, the pediatricians go through exactly what complaints the ten-year-old has. Her headache describes her as strong and throbbing. They are particularly pronounced on the right temporal area. The child does not have to vomit during headache attacks, instead it has two other symptoms: heavy sweating and palpitations.
In the evening she sweats the strongest
The child perspires independently of physical activity, most pronounced in the evening hours. The ten-year-old, however, has no fever and no chills. Again and again her heart races, first something, then faster and faster, before it finds its way back to a normal rhythm. In the past half year, the girl has eaten little and is emaciated. The child is also quickly exhausted.
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The young patient is actually underweight when admitted to the clinic, the doctors report to Olarinde Jeffrey Ogunmola in the American Journal of Case Reports. Her pulse is 100 beats per minute, which is normal for her age. But the blood pressure is significantly increased, as the physicians with several measurements on both arms determine - he is between 180 to 120 and 200 to 120.
Blood pressure
- The blood pressure measurement always gives two values, for example 120 to 80. The higher is the systolic blood pressure - it occurs while the heart is pushing blood into the arteries. The lower diastolic blood pressure prevails when the heart chambers relax and fill up.
The doctors want to bring the blood pressure with tablets in the normal range, but this does not succeed at first, although they try it with three different classes of medication. The pediatricians involve cardiologists in the treatment and give more medication, one of them directly into the blood. After five days, the child's blood pressure is 92 to 68.
What drove blood pressure so high?
The doctors test blood and urine of the child, where all values are normal. On an X-ray of the chest, the so-called aortic button is enlarged, which may be related to hypertension.
On an ultrasound of the abdomen, however, the doctors notice something in the right kidney. A computed tomography confirms that a tumor is growing in the kidney. The girl is operated on, the kidney is removed. Both the lymph nodes and the left kidney are unaffected and remain untouched.
An analysis of the removed tissue shows that it is a so-called renal cell carcinoma. Although this is the most common form of kidney cancer, it is very rare in children. In addition, this cancer in children is usually noticeable by the fact that blood is found in the urine or they suffer from pain in the right abdominal area. Both were not the case with the ten-year-old.
High blood pressure is also one of the possible consequences of renal cell carcinoma. After the operation, the blood pressure of the girl falls, the medication can be discontinued. After five days, the patient is discharged from the clinic.