A case of 30 year old female
33 year old female came with the chief complaints of :
1.arthralgia since 2 months
2.fever since 5 days
3.vomitings and loose stools since 4 days
4.abscess over the right thigh (?ruptured)
since 5 days .
HOPI :
Patient was apparently asymptomatic 2 months ago then she developed fever which is of low grade associated with polyarthralgia lasted for 15 days for which she used Tab . Paracetamol ,Tab.Diclofenac after which the patient still didn't get any relief
There's no effect of her symptoms on her daily activities and her occupation.
The patient took COVID vaccine
H/o small and large joint pains with swelling around the joints
Due to the persistence of fever and polyarthralgia the patient visited rheumatologist in the month of October (RF -Normal ,HB - 9 g/dl , ESR -110 )
There the patient was advised :
1.Tab .HCQ 200 mg OD for 2 weeks (8pm)
2.Tab.Prednisolone 20 mg OD for 2 weeks (8am)
3.Tab.Azathioprine 50 mg OD in the morning for 2 weeks
After using these medicines her symptoms got subsided
Today patient has come to our hospital with fever which is of high grade associated with chills and rigors , vomitings - non bilious ,non projectile , food and water as the content , stools - watery in consistency ,large volume mucous , no blood in stools
No h/o Malena ,hematuria
Past history :
Not a k/c/o diabetes mellitus , hypertension, asthma ,cad , tuberculosis
Past surgical history :
Tubectomy done 10 years ago
Personal history :
Diet -mixed
Appetite - decreased since 2 months
Bowel habits - regular
Bladder habits - urgency present
Sleep - adequate
No addictions
Family history :
Patient's mother is a known case of diabetes and hypertension since 10 years
Obstetric history :
Age of marriage - 18
P2L2
General examination :
Patient is conscious, coherent,cooperative ,thin built and poorly nourished
Mild pallor present
No cyanosis , icterus , clubbing,lymphadenopathy ,edema
Mild dehydration present
Vitals :
Pulse rate - 88 bpm
Temperature- 100 degree Fahrenheit
RR - 12 cpm
BP - 80/50 mmHg
Systemic examination :
CVS : S1 S2 + , no added murmurs
RS :BAE + ,NVBS heard
CNS : no focal neurological deficits
P/A :soft , non tender
No organomegaly
No distension
Bowel sounds heard
Local examination of the abscess :
1 x 1 cm wound present over the anterior aspect of left thigh with surrounding erythema .
Local rise of temperature +
Tenderness +
No pus discharge
(Diagnosis given by the surgery dept for the abscess - Ruptured sebaceous cyst )
Advice given for the abscess :
1.Tab CHYMEROL forte -TID
2.Tab Hifenac -P PO /BD
3.Tab Vit -C PO /OD
4.Regular dressings
Investigations sent on the day patient got admitted : ( 2/12/2021)
1.ECG
2.USG abdomen - no sonological abnormality detected
3.RFT : urea - 20 mg/dl , creatinine - 0.7 mg/dl ,Na+ - 146 meq/L , K+ - 4.2 meq/L , Cl- 105 meq/L
4.LFT : TB - 1.21 , DB - 0.26 , AST - 26 , ALT - 10 , ALP - 95 , TP - 5.9 , Albumin - 3.2 , A/G ratio - 1.22
5.Hemogram : HB - 8.5 g/dl , TLC - 1,300 , N/L/E/M - 61/27/2/10 , PLt - 1.19 , RBC - 2.90
PCV - 24.1 , MCV - 83.1 , MCH - 29.3
6.ESR - 85 mm
7.CUE : Sugar , albumin - nil , pus cells - 3 to 4
E.cells - 2 to 3
8.Malarial parasite - negative
9.Chest x-ray
Previous investigations of the patient :
13/9/2021 :
HB - 9.5 g/dl
TLC - 2,900
PCV - 28.1
PLt - 1.89
K+ - 2.8
23/10/2021 :
HB - 9 g/dl
TLC - 4,900
PLt - 2.69
R factor - normal
CRP - 9
ESR - 10
Alb - 3.9
TSH - 7.16 micro IU/ml
USG - free fluid in the pelvis
Provisional diagnosis :
Acute Gastroenteritis (infective cause ) with ruptured sebaceous cyst with polyarthralgia under evaluation.
Treatment given :
1.IVF - NS , RL @ 100 ml/hr
2.Inj Optinneuron 1 amp in 100 ml NS IV/OD
3.Inj Neomol 1 gm IV SOS (if temp >=101 degree Fahrenheit)
4.Inj Pantop 40 mg IV OD
5.Inj Zofer 4 mg IV TID
6.Inj Ceftriaxone 1 gm IV BD
7.Tab Sporolac -DS PO TID
8.Tab Dolo 650 mg PO TID
9. Tab Baclofen 12.5 mg PO SOS ( if hiccups persist )
10.ORS sachets in 1 litre of water - 100 ml /stool.
11.Tab Redotil 100 mg PO /BD
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