Jeruto* was a lively four-year-old, but that's not why we all flocked to her bedside.
We tried not to gawk, but she was in the “wrong” ward and had a peculiar diagnosis. She had no idea why she was suddenly so important, but she loved the attention and the gifts it brought.
When patients have a rare diagnosis, medical students are encouraged to see the patient because it is a once-in-a-lifetime opportunity and memory will serve them well if they happen upon a similar patient in future. Seeing just one physical sign in a patient will trigger a buried memory that goes a long way in diagnosing the patient on your examination table correctly.
Jeruto had come to the teaching hospital a year after her symptoms set in. At only three, she developed unexplained vaginal bleeding. She had always been a chubby baby, so her mother attributed her breast enlargement to fat. But the bleeding scared her.
At first she thought her daughter had been defiled, but careful inspection revealed no injuries.
She put the girl in diapers and consulted her mother-in-law. The two women in rural Nandi discussed an array of possible reasons for the girl’s abnormal situation and concluded that dark forces were at play. The child’s very religious grandmother, opted for the familiar path – prayer by the priest.
For a while, the bleeding stopped and they presumed that the baby was fine, but three months later, the bleeding resumed. This time round, Jeruto’s father was home on leave from his workstation in Mombasa. He would hear nothing of the prayer options and sought medical help from a nearby health centre.
For months Jeruto was treated for various medical conditions: urinary tract infection, dysentery and even bilharzia, but the bleeding would not cease.
Eventually, one of the healthcare providers noted a new development, Jeruto had an abdominal swelling that was growing rapidly. He referred her to the teaching hospital for further care.
Jeruto was diagnosed with precocious puberty, a condition so rare, it happens in one in 5,000 to 10,000 children. It is five times more common in girls than boys.
Whereas the more common type is where there is an abnormality in all the hormones responsible for reproduction, all the way from the brain (hypothalamus and pituitary gland) to the ovary (in girls) or testes (in boys), Jeruto’s condition was even rarer.
Her condition was a result of an ovarian tumour known as the granulosa cell tumour. It is commonly not cancerous when it occurs in children, but it leads to a lot of distress, both for the child and her parents.
The abdominal swelling was a growing tumour that was producing the female sex hormone, oestrogen, which was causing all these puberty signs.
At the tender age of four, Jeruto was being inadvertently turned into a woman. She was saved the agony of having to understand the ramifications of the condition, but her parents were distraught.
In our set-up, it is not uncommon for such rare conditions to go untreated for prolonged durations. It is almost taboo for a young child to have vaginal bleeding and conclusions are quickly drawn on the supernatural occurrence. Yet this is a definite sign of things going wrong that require immediate medical intervention for proper diagnosis and treatment.
It is normal for newborn girls to bleed from the vagina or have a semblance of breast buds in the first few weeks of life. This is a result of high levels of the mother’s oestrogen hormone in the baby. After birth, the baby ceases to receive these hormones and their levels drop over time, leading to the disappearance of these symptoms.
However, new onset of growing breast tissue, vaginal bleeding and abnormally rapid growth in height requires a thorough review. Ovarian tumours, abnormality of the adrenal glands or hypothyroidism could be causing mayhem. Reports have been made in babies as young as four months!
Thankfully for Jeruto, the able multidisciplinary team of specialists drawn from key departments were up to the task.
We thronged the operating room, and she underwent successful surgery to remove the tumour. The surgical skill on display was one of a kind considering the size of our patient.
The laboratory confirmed that the tumour was not cancerous amid celebratory cheer from all of us.
Jeruto went on to recover very well, further proving her resilience. She had to make do with losing one ovary, but the remaining one would serve her well in future. The bleeding stopped and the breast tissue shrunk. Her childhood had been redeemed!
While Jeruto grew up with a scar, wearing it proudly as a badge of honour for what she survived, her mother definitely found peace. The question of how to use a sanitary pad on a pre-school child had been laid to rest and her daughter could now happily ditch the diapers!