40 year male with Fever

August 22, 2022

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PRESENTING COMPLAINTS:

C/O Fever since 4 days.

C/O B/L Lower limb pain since 4 days.

C/O Abdominal pain since 4 days.

C/O Nausea since 4 days.

HOPI:

A 40 year male presented to the OPD with complaints of High grade Intermittent fever associated with chills which was relieved on taking medication and having Squeezing type of abdominal pain at the periumbilical region associated with nausea leading to decreased food intake since 4 days. History of bilateral lower limb pain since 4 days. History of dry cough since 4 days not associated with chest pain, Shortness of breath, Orthopnea, PND. No history of pedal edema, bleeding manifestations and burning micturition. He sought for consultation at an local hospital after taking Antipyretic medications for 2 days and was diagnosed as having Typhoid and started treatment for the same; but the fever was not subsided; The Patient sought for consultation here and now admitted for further evaluation and management.

PAST MEDICAL ILLNESS:

No Comorbidities.

SURGICAL HISTORY:

S/P - Right Forearm plating done under SA in 2018.

PERSONAL HISTORY:

Moderately built and nourished.

Normal Appetite.

Non vegetarian.

Bowel and bladder are regular.

Occasional Alcoholic started at the age of 20; 180ml; stopped in 2016( age of 34).

GENERAL EXAMINATION:

Patient was conscious and coherent.

No P/I/C/C/L/E.

Temp : 99.6°F; PR: 92bpm; RR: 18cpm; BP: 110/70mmHg; SpO2: 98%@RA; GRBS: 116mg/dl.

CVS: S1,S2+; R/S: BAE+, Clear; P/A: Soft, Non tender, mild Spleenomegaly+; CNS: NFND.

COURSE INTHE HOSPITAL:

A 40 year male presented to the OPD with the above mentioned complaints. Upon arrival priliminary examination was done and History noted. Necessary initial workup was done. His platelet counts were 22000 at the time of admission and had no signs of bleeding manifestations, postural drop and Hess test was negative. His platelet count were 15000 on day of admission at 9pm. The patient and his attendees were counselled regarding the need for platelet transfusion. His blood group was O+. Dengue for NS1 was positive and IgM, IgG were negative.

ECG at presentation:

USG ABDOMEN was done on 22/08/2022 which showed findings of:-

1. Liver of normal size and echotexture with normal PV & CBD.

2. Gall bladder was distended and increased wall thickness - s/o Gall bladder wall edema.

3. Spleen 13.8cms (mild Spleenomegaly).

4. Rt kidney 10×4cms; Lt kidney 11×4.5cms with normal size and echotexture, CMD maintained and PCS was normal.

5. Mild Ascites @ fluid collection at pelvic and perihepatic spaces.

2D echo was done on 22/08/2022, which showed:

Trivial TR/AR; No MR; Sclerotic AV; No RWMA; EF 60%; No MS/AS; Good LV Systolic function; Diastolic dysfunction.

His Thyroid profile was T3 : 1.16; T4: 12.36; TSH: 5.34. On 23/08/2022 his has complains of severe headache and passage of streaks of blood in stools. So he was transfused with 1 unit of SDP transfused was done. Repeat plt count after transfusion was 1.4 lakhs; Hb 18.5 and TLC 5700.

During the stay in hospital he was treated with IV Fluids, antibiotic, Antipyretic and other supportive medications. His condition has improved and now being discharged ina hemodynamically stable condition.

Chest xray PA view: