fever projr -SCRUB TYPHUS -22/M 39691

 scrub typhus - 202239691

Diagnosis

MODS ( meningoencephalitis, hepatitis& glomerulonephritis) 2to SYSTEMIC VASCULITIS ASSOCIATED WITH ?RICKETTSIAL SPOTTED FEVER, ?VIRAL HEMORRHAGIC FEVER, ?HUS/TTP

Case History and Clinical Findings

Pt came to casualty in state of altered sensorium with slurring of speech on 20/09/22Pt does hotel work once he left his house due to psychological issues due to sisters marriage since 2 years and stays alone.He was apparently asymptomatic 5 days back from 20/09/22. He had fever 5 days back which was high grade, continuous, associated with chills. No history of cold and cough . He went to local hospital got treated but the fever did not subside.Later after a day he consumed beer, had.He had 1 episode of vomiting and loose stools since 3 days. (2 days back),today he was in room and had a binge of alcohol suddenly he had involuntary movements of all 4 limbs associated with frothing, uprolling of eyes, post ictal confusion, he bit his lower lip no tongue bite . He had 1 episode of vomiting at the time of involuntary movement, and loose stools, foul smelling.Since previous day afternoon, pt was in altered sensorium , with slurred speech, and deviation of mouth.. He had altered sensorium and involuntary movements.No c/o weakness of upper limb and lower limb.No h/o cough, cold, palpitations, syncopal attacks, chest pain

PAST HISTORYN/k/c/o - DM, HTN, EPILEPSY,TB , ASTHMAk/c/o - alcoholic since 5 yearsFAMILY HISTORYNo significant historyPERSONAL HISTORYappetite- normalDiet- mixedBowel and bladder

- normalSleep- regularHabits - alcohol consumption since 5 yrs, with history of SmokingGeneral examination:On examination:Pt is in altered sensoriumNo pallor, Icterus, clubbing, cyanosis lymphadenopathy, edema, macular rash seen over palm and echymotic patch on triceps area.

VITALSBP 110/60mmHgPR 110bpmTemp. 100°FCVS S1, S2 +RS - BAE

+, NVBS

CNS EXAMINATION:NERVOUS SYSTEM EXAMINATIONa. Consciousb. Not Oriented to

time, place and personc. Speech and language –no aphasia, dysarthria, dysphoniad. Memory

–immediate-retention and recall, recent and remote - not intactMOTOR examinationMeningeal signsKernigs sign +Brudzinski sign -Power: Rt. LtUL +4/5. -4/5LL.

+4/5. -4/5ToneUL. N NLL. N. NHand grip: 100%. 100%

Brief course of treatment:The patient came to he the casualty in altered sensorium after examination. An MRI was done under midazolam . Blood sample was collected and was sent for serology, hemogram , RFT,LFT. He had deranged LFT, RFT.Platelet transfusion was done prior to Lumbar puncture for CSF fluid analysis. Lumbar puncture was done under strict aspetic precautions.The patient attenders have ben explained about the procedure and the complications associated. After giving 2cc of lignocaine as local anaesthetic lumbar puncture was attempted at L3-L4, and L4-L5. The procedure was not successful as the patient was irritable. The procedure was continued after giving 2cc of Midazolam .His vitals were stable post procedure. He was on conservative treatment.He was referred to Psychiatry department in view of delirium and alcohol withdrawl. After evaluation he was on INJ. Lorazepam 2mg IM/ slow IV sos , dim lighting, orientation cues 2nd hourly , adequate nutrition and hydration.

Investigation

MRI-BRAIN : Cerebral parenchyma shows normal grey/white matter differentiation

Basal ganglia and thalami are normal Cranio-vertebral and Cervico medullary junctions are normal. Sella, pituitary , parasella regions are

normal. Stalk and hypothalamus are normal. Posterior pituitary bright spot is normal.

No evidence of infarcts on DWI sequences. No evidence of abnormal calcifications ,haemorrhages or vascular anomalies on SWI sequences. Orbit and globe contents are normal.

IMPRESSION: NO ABNORMALITIES DTECTED IN BRAIN.

30/09/22

hb-11.5

pcv-35.2

TLC-8800

PLT-2.36


RBC-4.27

29/09/22

hb-12.4

27/09/22

hb-12.7

PCV-37.7

TLC-14300

RBC-4.72

Treatment Given(Enter only Generic Name)

IV FLUIDS NS RL @75 ML/HR

INJ. TRAMADOL 100MG IN 100ML NS IV/BD

INJ. DOXY 100MG IV/BD

INJ. DEXA 8 MG IV/BD

INJ. THIAMINE 200 MG IN 100 ML NS IV/OD

INJ. LOAZEPAM 2CC IV/STAT

INJ. MIDAZ 2CC DILUTED IN 2ML NS/IV STAT

TAB BENFOMATE PLUS /PO/OD

SYP DUPHALAC 30 ML PO/TID

PLENTY OF ORAL FLUIDS

MONITOR VITALS AND INFORM SOS

TAB LASIX 20 MG PO/STAT.

Advice at Discharge

TAB DEXA 4 MG TWICE DAILY FOR 3 DAYS

TAB ULTRACET 1/2 TAB ONLYH ON PAIN

TAB BENFOMATE PLUS 1TAB PO ONCE DAILY

PLENTY OF ORAL FLUIDS





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