fever projr - unclassified 15/M

 unclassified : 

date of admission 17/10/2022 

date of discharge 1/11/2022



Diagnosis

PYREXIA OF UNKNOWN ORIGIN, GENERALISED LYMPHADENOPATHY WITH RAYNAUDS PHENOMENON WITH CRITICAL LIMB ISCHEMIA OF RIGHT INDEX FINGER AND RIGHT LITTLE TOE .

( EXCISION BIOPSY OF CERVICAL LYMPHNODE--->SINUS HISTIOCYTOSIS)

Case History and Clinical Findings

CHIEF COMPLAINTS:

• FEVER since 3 days

• LOOSE STOOLS since 3 days.

•VOMITING since 3 days.

• bluish discoloration of fingers of upperlimb since yesterday.

History of present illness:

Patient was apparently asymptomatic 3 days back then he developed

Fever, which is high grade fever, not relieved on taking medication.

Loose stools, 3-4 episodes/ day till yesterday.

H/O 3 episodes of vomiting on day 1, which is bilious, non projectile.

Associated with head ache in occipital region since 3 days.

• from yesterday patient developed bluish discoloration of fingers.


PAST HISTORY:

Not a known case of, hypertension, diabetes,CAD, EPILEPSY, ASTHAMA.

H/O injury to index finger and surgery done to finger at 1 year of age.

FAMILY HISTORY:

NO SIMILAR COMPLAINTS IN THE FAMILY.

Personal history:

Diet- mixed

Appetite- normal

Bowel and bladder movements- Regular

Allergies- No

Addictions- No

GENERAL EXAMINATION:

Pt is conscious, coherent and cooperative

At the time of presentation hand andfeet are cold compared to forearm.

CYANOSIS - PRESENT

No pallor, no icterus, , no clubbing, no lymphadenopathy.

VITALS- day 1

TEMP-101.4 F

BP-100/60

Pulse rate-86bpm

RR- 18cpm

ABDOMINAL EXAMINATION:

Umbilicus inverted , No abdominal distention,no visible pulsations,scars and swelling.

PALPATION: Soft, non tender, no organo megaly.

AUSCULTATION:

BOWEL SOUNDS HEARD

CARDIOVASCULAR EXAMINATION:


No visible pulsations, scars, engorged veins. No rise in jvp

Apex beat is felt at 5 Intercoastal space medial to mid clavicular line.

S1 S2 heard . No murmurs.

Respiratory system: Shape of chest is elliptical, b/l symmetrical.

Trachea is central. Expansion of chest is symmetrical

Bilateral Airway Entry - positive

Normal vesicular breath sounds

CNS EXAMINATION:

No signs of meningeal signs

Cranial nerves: normal

Sensory system: normal

Motor system: normal

Reflexes: Right. Left.

Biceps. ++. ++

Triceps. ++. ++

Supinator ++. ++

Knee. ++. ++

Ankle ++ ++

gait-normal.

Investigation

HEMOGRAM 17/10/22

Hemoglobin-14.5

TLC-5500

PLATELETS-1.70

PCV-43

HEMOGRAM 28/10/22

Hemoglobin-10.3

TLC-5800

PLATELETS-1.30

PCV-31.4


ESR ON 19/10/22-85

ESR ON 22/10/22-80

ESR ON 27/10/22-110

ESR ON 28/10/22-110

LYMPHNODE CBNAAT IS NEGATIVE FOR MTB.

Treatment Given(Enter only Generic Name)

Depending on patient clinical status and probable differentials the following Antibiotics were started.

1.INJ DOXYCYCLINE 100mg /IV/BD X 5 DAYS

2. INJ CEFTRIAXONE 1gm /IV /BD X6DAYS

3.INJ FALCIGO 120mg - 3 doses given(0,12,24 hours)

TAB AZITHROMYCIN 500mg PO/OD started to cover atypical infections.

Inspite of all these as fever was not subsiding,all these antibiotics stopped and escalated to Inj Meropenem 1gm /IV/BD.

Eventually stopped after 2 days as Fever was not subsiding.

i/v/o Autoimmune etiology steriods TAB PREDNISOLONE 40mg /PO/OD started from 26/10/22 to 1/11/22.

Fever subsided after starting on steriods.

BRIEF COURSE IN HOSPITAL:

14 year old male came with c/o fever,vomiting and discolouration of fingers of both upper limbs,diagnosed as Pyrexia of unknown origin with generalised lymphadenopathy with raynauds phenomenon. Patient is having continuous fever spikes inspite of antibiotics and antipyretics.His Brucella ( IgG and IgM) and scrub typhus antibodies are negative.Excision biopsy of cervical lymphnode and inguinal node done under general anaesthesia (29/10/22).Frozen section of the biopsy is inconclusive and the biopsy showing sinus histiocytosis.Today (1/11/22) patient developed critical limb ischemia of right index finger and right little toe.Patient need urgent CT Angiogram and Vascular surgeon intervention for the salvage of the limb.so,referring the case to the higher centre for urgent vascular surgeon intervention.

Advice at Discharge

patient developed critical limb ischemia of right index finger and right little toe.Patient need urgent CT Angiogram and Vascular surgeon intervention for the salvage of the limb.so,referring the case to the higher centre for urgent vascular surgeon intervention.






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