fever projr sle 14/F 11545

 sle - 202311545

Diagnosis




GLOMERULONEPHRITIS SECONDARY TO ? LUPUS ? AUTOIMMUNE ETIOLOGY

WITH POLYSEROSITIS SECONDARY TO AUTOIMMUNE / TB

WITH ANEMIA (NC/NC WITH MICROCYTES SECONDARY TO CHRONIC INFLAMMATION

WITH SCABIES

Case History and Clinical Findings

Presenting compalaints13year old femaleCame with chief complaints of Shortness of breath since yesterday (decreased now)4 episodes of vomitings since yesterday 10pmBirth history1st child2nd degree consanguineous marriageBorn in 2010LSCSFather has no idea about immunisation statusMother-has 2 childrenThe current pt is the elder one(birth in 2010)2nd child born in 2013In 2014 mother diagnosed with kochs-expired in 2022 sept(did not use ATT regularly)Patient was apparently asymptotic till the age of 11yearsShe was sent to hostel for studiesAfter few days of hostel stay she noticed that she has bilateral neck swellingsSo she was taken to RMP with complaints of neck swellings,fever and cough on and offRMP has initiated her on ATT as her mother has also has kochsThey used ATT for 2months started in 2021 juneAfter initiating ATT fever increased so they stopped ATT and was referred to Hyd by the RMPPatient was taken to NF hospital where she was evaluated for kochs but none of the investigations showed AFB,at that time she also had complaints of knee pains and wrist joint painsIn view of joint pains she was referred to N hospitalIn N hospital they suspected it to be autoimmune and started her on Tab Wysolone and Tab HCQ ,which she used for 15 days and stopped and later did not go there for follow up(ANA ELISA-equivocal,ANA IFA- negative,Anti Ds DNA ELISA-Positive,Anti Ds DNA IFA negative)She was taken to another local hospital with c/o joint pains,facial puffiness,pedal edema,fever ,coughLymph node biopsy was done in May 2022 ?reactive(no report available but attendor was informed that it was negative for kochs)So Mycobacterial gene expert test was done on blood sample which was also negativeBut she was initiated on ATT empirically on may/2022.10-15days before starting ATT attendors have noticed that she is developing facial rash and Hair loss,due to hair loss scalp rash also became evident.History of past illness:K/C/o extra pulmonary tb (1year back used att for 6 months)N/k

/c/o hypertension, DM, epilepsy, cad, CvaTreatment history:Used att for 6 months for extra pulmonary tb.Personal history:SingleOccupation:studentDecreased appetite and micturitionGeneral examination:Pallor +Edema +No icterus cyanosis clubbing lymphadenopathySystemic examination:CVS: s1 s2 heard, no murmursRS: BAE + , NVBSP/a : free fluid presentTenderness + at right and left hypochondria and epigastriumCns: pt is C/C/CNo FNDHMF + Right. LeftBiceps. ++ ++Triceps. 2+ 2+Supinator. + +Knee 2+ 2+Ankle. + +OPHTHALMOLOGY REFERRAL WAS DONE ON 15/3/23 AND ADVISED EYE DROPS LUBRIX QIDDERMATOLOGY WAS DONE IN VIEW TO RULE OUT SCABIES AND THEY DIAGNOSED AS SCABIES AND ADVISED 5 PERCENT PERMETHINE LOTION [ DAY 1 AND DAY 8] [60 ML ] OVERNIGHT APPLICATION AS ADVISED.NEPHROLOGY REFERRAL WAS DONE AND ADVISED RENAL BIOPSY. AS THE PATIENT IS HAVING SCABIES RENAL BIOPSY DEFERRED TO A LATER DATE

Investigation

ULTRASOUND

IMPRESSION

BILATERAL GRADE II RPD CHANGES

GB WALL EDEMA


MODERATE ASCITIS

BILATERAL PLEURAL EFFUSION

MODERATE PERICARDIAL EFFUSION

SUB MUCOSAL EDEMA OF SMALL BOWEL LOOPS

2D ECHO

SINUS SIATUS

LARGE PERICARDIAL EFFUSION

NO TAMPONADE

REVIEW 2D ECHO

IMPRESSION- PERICARDIOCENTESIS ADVISED

HEMOGRAM

14/3/23

HB- 6.8

PCV 23.3

TLC- 5400

RBC- 3.01

PLATELET- 1.20

ESR- 70

15/3/23

HB- 7.5

PCV- 24.6

TLC- 4200

RBC- 3.2

PLATELET- 1.57

16/3/23

HB- 7.2

PCV 23.7

TLC- 7700

RBC- 3.22


PLATELET-

17/3/23

HB- 7.1

PCV 23.6

TLC- 8000

RBC- 2.84

PLATELET-

18/3/23

HB- 6.8

PCV 21.8

TLC- 8400

RBC- 2.84

PLATELET-

19/3/23

HB-6.8

PCV- 21.6

TLC- 10500

RBC- 2.8

PLATELET-

URINE C/S-

1.5

1.7

1.7

2.2

NO GROWTH DETECTED

BLOOD C/S- BACTIC. SKIN COMMENSALS GROWN

Treatment Given(Enter only Generic Name)

FLUID RESTRICTION <1.5L/DAY

SALT RESTRICTION <1.2GM/ DAY

INJ LASIX 40 MG/IV/BD

INJ MONOCEF 1GM IV/BD [DAY 7]

T.WYSOLONE 20 MG PO/BD

T. HCQ 100MG PO/OD

T. ALDACTONE 25 MG PO/OD


INJ PAN 40 MG/IV/OD

INJ ZOFER 4MG/IV/SOS

SYP SUCRALFATE 10 ML PO/TID

Advice at Discharge

FLUID RESTRICTION <1.5L/DAY

SALT RESTRICTION <1.2GM/ DAY

T.LASIX 40MG /PO/BD

T.WYSOLONE 20 MG PO/BD

T. HCQ 100MG PO/OD

T. ALDACTONE 25 MG PO/OD

SYP SUCRALFATE 10 ML PO/TID



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