60 year old male who is a farmer by occupation came to casualty with the complaints of
fever since 15 days
Cough since and sob since 5 days
Hematuria and urine output since 2 days
HOPI :
Patient was apparently asymptomatic 15 days back ,he had history of fever which is of high grade , intermittent , associated with chills and rigors for 2 days then he visited RMP ,though he took oral medication fever did not subside
Then he was taken to hospital in nalgonda on 13th Jan ,2022 as Dengue (NS1 positive) patient had h/o bleeding manifestations like hematuria and Malena
2 SDP transfusions done on 17th and 19th of January ,2022
Hrct (13/1 ) :right moderate pleural effusion ,sub segmental atelectasis changes in medical segment of right middle lobe (corads -2 )
Bleeding manifestations of patient subsided after 1 week
He didn't have any O2 requirement during his hospital stay
He got discharged on 20/1/2022
After 3 days of discharge he again had increased rise in temperature in the evenings .fever is of high grade , associated with chills and rigors
Hematuria ,SOB (grade 2-3 ) associated with dry cough
No significant weight loss
Past history :
Not a case of DM ,HTN ,asthma ,CAD , TB
Personal history :
Appetite - normal
Sleep -adequate
Bowel habits - regular
Bladder habits - hematuria
Occasional alcoholic -drinks 90 ml
Tobacco -since 25 years
Smoking - chronic smoker since 40 years ,smokes 2 cigars/day
No significant family history
General examination :
Patient is conscious , coherent and cooperative , malnourished
No pallor ,icterus , cyanosis, clubbing, lymphadenopathy ,edema
Vitals :
Temp - 101 degree f
Pr -88 bpm
RR -34 cpm
Bp -120/70 mmHg
Spo2 - 96 % at RA
GRBS -110 mg/dl
Systemic examination :
CVS - S1 S2 +
Rs - dyspnea +
Position of trachea -central
Percussion : dull note over right infra-scapular ,infra axillary region
Auscultation : decreased breath sounds on right infra mammary , infra axillary and infra scapular areas
Per abdomen : soft ,non tender , no organomegaly , bowel sounds +
CNS - nfnd
Pleural tap :
Pleural fluid cytology :
Wbc - 650 cells
Predominantly 90% lymphocytes and 10% neutrophils
RBC plenty
PT - 20
APTT - 39
INR -1.4
BGT - A positive .
Diagnosis :
Hematuria under evaluation
With right sided pleural effusion
With fever under evaluation
Treatment :
(Therapeutic pleural tap of 400 ml done )
1. Head end elevation
2.o2 inhalation to maintain spo2 >=96%
3.inj tranexa 500 mg IV/stat
4.inj pantop 40 mg IV/stat
5.inj Zofer 4mg iv/sos
6.neb with budecort iv/stat
7.inj Neomol 100 ml iv/tid
8.tab pcm 650 mg po/sos
28/1/2022 :
Pulmonology referral
USG abdomen :
2d echo :
29/1/2022 :
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