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



Comments

Post a Comment

Popular posts from this blog

42Y/M C/o CKD 2* to Diabetic Nephropathy

Image
This is an online e log book to discuss our patient identified health data shared after taking his/her guardian signed informed consent. Here we discuss our individual patient problems through a series of inputs from available global online community of experts with a aim to solve those patients clinical problem with collective current best evidence based inputs. This blog also reflects my patient centered online learning portfolio and valuable inputs on the comments box is welcome. I have been given this case to solve in an attempts to understand the topic of patient clinical data analysis, to develop my competency in reading and comprehending clinical data including history, clinical finding, investigation -------------------------------------------------------  A 42 year old male working as a rice farmer , hailing from Nalgonda presented to the OPD with shortness of breath , loss of consciousness 2 days ago history of Present illness   patient was apparently asymptomatic 15 years ag
Read more

63F Urinary incontinence 4 years ,RA on DMARD 25 years

Image
 A 65 year old Hindu woman a housewife a resident of west bengal having a Bsc degree and belonging to middle class according to modified kuppuswamy scale presented to the general medicine OPD with  chief complaints of  -constipation since the past 3 years  -continuous dribbling of urine since the past 4 years    History of presenting illness   Patient was apparently asymptomatic 26 years ago , when she developed continuous dull aching pain in both the knee joints , which was exaggerated in the mornings and was bearable throughout the day , it was aggravated on walking and relieved on rest  associated with redness around the knees no history of trauma no history of evening rise of temperature  no history of cosmetic deformity(varicosity, skin discoloration) -she underwent a bilateral knee replacement for knee stiffness  -is on DMARDS since 25 years  patient was incidentally diagnosed with hypertension 20 years ago during a follow up visit  -she was started on antihypertensive medicat
Read more

MY EXPERIENCES WITH GENERAL CELLULAR AND NEURAL CELLULAR PATHOLOGY IN A CASE BASED BLENDED LEARNING ECOSYSTEM'S CBBLE

Image
  Greetings,  I am Anahita Behara a final year medical student from India .I welcome you to join me on my journey in navigating the topsy turvy road of learning in medical school.      CBBLE PAJR PARTICIPATORY LEARNING ACTION RESEARCH DISCLAIMER  NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS/HER GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.   I remember the first-time general medicine sparked interest in me .  Due to covid restrictions  our second year of medicine was conducted online .We had telephonic conversations with the patients to take their history and subsequently document elogs or online case logs. I vividly recall the case of a 70 year old woman with hypothyroidism who wa
Read more