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Prof. N. Gupta Unit

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HISTORY (Cont.)

No h/o

cough, expectoration, sore throat.

syncope, presyncope, joint swelling. vomiting, diarrhoea, pain abdomen.

swelling of limbs, burning micturation.

No h/o

exposure to drugs, radiation,toxins,tick.

chest trauma, TB, HT, DM.

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EXAMINATION

GPE

o Patient conscious, oriented, temp. 1040F.

o PR- 130/min, BP- 90/60 mm Hg, RR- 28/min.

o Pallor present.

o No icterus, cyanosis, clubbing, pedal edema.

o JVP not raised. No thyromegaly or LAP.

CHEST :B/L basal crackles.

CVS, CNS, ABDOMEN : WNL.

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INVESTIGATIONS

CBC :Hb 8.5, TPC 78000, TLC 5800

LFT, KFT : WNL

CXR

:

WNL ECG :

P/S for MP : Negative

URINE -R/M : WNL

- C/S : No growth

BLOOD C/S : Sterile

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INVESTIGATIONS(Cont.)

CPK :27 U/L

TROPONIN T : Negative

OPTIMAL : Positive for plasmodium vivax

ECHO : Mild MR, TR, minimal PE.

: jerky septal wall movement

:LV systolic dysfunction, EF 40%

s/o myocarditis.

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MANAGEMENT & COURSE

Bed rest, O2, Antipyretics, Tab. Chloroquine.

Monitored clinically and with ECG, CPK.

Patient improved and became asymptomatic. Repeat ECHO : LVEF 50%

Serology for : COXSACKIE, ADENO, PARVO,

HIV, HCV : Negative.

CMRI :

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FINAL DIAGNOSIS

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CASE - 2

Patient A, 15yr/M, resident of Delhi,

presented with c/o

Fever 6 days

Yellowish discolouration of sclera 3 days

Abdominal pain 2 days

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HISTORY (Cont.)

No h/o vomiting, abdominal distention, g.i. Bleed.

diarrhoea, clay coloured stool, pruritus.

cough, expectoration, chest pain, dyspnoea.

burning micturation, soft tissue swelling, rashes.

bone pain, joint pains, ear discharge, trauma .

No past h/o blood transfusion, jaundice, tuberculosis,DM.

cardiovascular disease, haematological disorder.

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EXAMINATION

GPE

o Patient conscious, oriented, temp101.40F.

o PR 104/min, BP 120/70mmHg, RR 16/min.

o Icterus ++o No pallor, cyanosis, clubbing or LAP. JVP N.

o No skin, nail, bone or joint abnormalities .

ABDOMEN :2 cm splenomegaly. RESP. SYSTEM, CVS, CNS : WNL

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INVESTIGATIONS

CBC : Hb-10.4, TPC- 46000, TLC-6500, Retic.Count-3.6%

LFT :T.Bil-4.8, D. Bil-0.9, AST-25, ALT-27

KFT, CXR, ECG : WNL

P/S for MP : Negative

LDH :1334 U/L

URINE C/S : No growth

BLOOD C/S :Sterile OPTIMAL : +ve for plasmodium vivax.

HBsAg, Anti HCV : negative.

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INVESTIGATIONS (Cont.)

USG Abdomen : Splenic abcess 2.8*1.7 cms.

CECT Abdomen : Splenic abcess 3.1*1.8 cms.

No other septic foci in abdomen and pelvis. ECHO : No e/o infective endocarditis.

ANA, RF, HIV :

Splenic aspirate :

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MANAGEMENT & COURSE

Inj.Artisunate, Pantoprazole, Ceftriaxone ,

Tab. Doxycycline, Folic acid, Primaquine.

Symptomatic improvement .

TPC and LFT recovered.

Repeat USG shows decrease in abcess size.

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CASE - 3

Patient Mrs. S, 55year/F, resident of UP,

presented to surgery em. with c/o

Fever : 7 days

Pain abdomen : 4 days

Vomitting : 4 days

Yellowish discolouration sclera :3 days

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HISTORY ( Cont.)No h/o

Abdominal distention, g.i. Bleed.

Diarrhoea, constipation.

Pruritus, clay coloured stool, trauma, burn.

Cough, expectoration, chest pain, dyspnoea.

Burning micturation, altered sensorium.

No h/o DM, HT, CVA, CAD, TB, Cholelithiasis, Alcohol.

Jaundice, blood transfusion in past.

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EXAMINATION

GPE

o Conscious, oriented, temp.1030F,BMI-24kg/m2

o PR 110/min, BP 108/76mm Hg, RR 18/min

o Icterus ++o No pallor, cyanosis, clubbing, PE or LAP. JVP N.

ABDOMEN :Rt.Hypochondrial tenderness

Hepatosplenomegaly ++ CHEST, CVS, CNS : WNL

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INVESTIGATIONS

CBC: Hb-12.3, TLC-8400, TPC-26000Retic. count 3.4%

LFT :T.Bil-13.1, D.Bil-2.7, AST-45,ALT-32

KFT

CXR WNL

ECG

Amylase : 46 U/L

P/S for MP :Ring and gametocytes ofP. vivax

LDH :784 U/L

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INVESTIGATION (Cont.)

USG Abdomen :

Liver 15cm, fatty change, no SOL/IHBD

dilatation, Spleen 15.2cm.GB thickened,

edematous (wall thickness 12mm) with

pericholecystic edema, No e/o calculi.

Blood C/S : Sterile

Urine C/S : No growth

HBsAg, Anti HCV : Non Reactive

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MANAGEMENT & COURSE

IV fluids, Inj. Pantoprazole, inj. Perinorm.

Tab. Quinine and Doxycycline.

Symptomatic improvement.

TPC and LFT recovered.

Repeat USG Abdomen : resolution of

pericholecystic collections and decrease inwall thickness.

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FINAL DIAGNOSIS