feverprojr FUNGAL 50/M

 fungal - 

date of admission 6/6/2023 

date of discharge 14/6/2023



PYREXIA SECONDARY TO CAVITATORY PNEUMONIA (WITH ASPERGILLOMA ? PULMONARY TB ) KLEBSIELLA PNEUMONIA WITH UNCONTROLLED SUGARS ( RESOLVED) WITH ANAEMIA OF CHRONIC DISEASE ( NC/NC)

Case History and Clinical Findings

PATIENT CAME WITH CHIEF COMPLAINT OF COUGH SINCE 7 DAYS MORE OF DRY, ASSOCIATED WITHLESS AMOUNT OF SPUTUM, MUCOID. BLOOD TINGED AGGRAVATED ON CHANGING POSITION FROM LYINGDOWN TO SITTING POSITION, NO RELIVING FACTORS.FEVER SINCE 7-DAYS HIGH GRADE.-NOT ASSOCIATED WITH CHILLS AND RIGOREVENING RISE OF TEMPERATURE.ASSOCIATED WITH SWEATING.SOB GRADE - I MMRC -: 7 DAYSMORE ASSOCIATED WITH COUGH, RELEIVED ON REST.NOT ASSOCIATED WITH WHEEZE:NO H/O SIMILAR COMPLIANTS IN THE PASTNO PAST H/O TB, LOSS OF APPETITE, LOSS OF WEIGHT.K/C/O: DM+ SINCE 2YEARS .N/K/C/O HTN,CAD ,BR ASTHMA ,EPILEPSY .H/O RTA 1 1/2 YEAR BACK.FRACTURE OF NECK OF FEMUR WITH DYNAMIC HIP SCREW SURGERY DONE IN OUTSIDE HOSPITAL.IMMOBILISATION 1 MONTH TO 1-1/2 YEAR BACK- H/O -ELECTROCUTION 4-YEARS BACK - BURNS BOTH HANDS.COURSE IN THE HOSPITAL:PATIENT CAME WITH UNCONTROLLED SUGARS ON CHECKING HIGH GRBS HIGH, HE WAS GIVEN 6U INSULIN IV/STAT 2 DOSES GIVEN ON 6/6/2023 AND WAS STARTED ON SUBCUTANEOUS INSULIN TID SINCE THEN .GRBS CHARTING:6/6/23.4PM- HI - 6U HAI GIVEN.6PM- 456 MG/DL.8PM- 248 MG/DL.7/6/23.6AM-347 MG/DL.2PM-343 MG/DL- 16U HAI GIVEN.8PM-122MG/DL- INJ HAI GIVEN.8/6/23.2PM-249MG/DL.8PM-89MG/DL.9/6/23.2AM- 99MG/DL.8AM -149MG/DL-4U HAI GIVEN.2PM-150 MG/DL- 2U HAI GIVEN.8PM-220MG/DL-8U HAI GIVEN.10/6/23.8AM- 67MG/DL.2PM- 258 MG/DL.8PM-327 MG/DL.11/6/23.8 AM- 150MG/DL.8PM-335MG/DL-HAI 4U GIVEN12/6/238AM -112MG/DL8PM-255 MG/DL13/6/232AM- 117MG/DL8AM-150MG/DL10PM-354 MG/DL-NJ HAI 6U GIVEN.14/6/23.8AM -182 MG/DL.X RAY WAS DONE ON 6/6/2023 - CONSOLIDATION SEEN.REFERRED TO PULMO I/V/O CHEST X RAY CHANGES ? MILIARY TB.TREATMENT ADVISED:1. SYP GRILLINCTUS DX 2 TABLE SPOONS PO/TID.2. TAB DOLO 650MG PO/TID.3. INJ NEOMOL 100ML IV(>101F).4. MONITOR VITALS.HRCT WAS DONE ON 7/6/2023 AFTER PULMO OPINION -CT IMPRESSION:-THIN WALLED CAVITY IN APICOPOSTERIOR SEGMENTS OF LEFT LUNG UPPER LOBE WITH SURROUNDING CONSOLIDATION- INFECTIVE.- EVIDENCE OF FUNGAL BALL WITHIN THE ABOVE CAVITY - ASPERGILLOMA.- PANCREATIC CALCIFICATIONS CON
SISTENT WITH- CHRONIC CALCIFIC PANCREATITIS.ITRACONAZOLE 200MG WAS STARTED ON 8/6/2023 AND CONTINUED TILL 14/6/2023.REVIEW PULMO OPINION WAS TAKEN AND SUGGESTED TO CONTINUE SAME TREATMENT.TAB ITRACONAZOLE 200MG BD FOR TWO WEEKS.PATIENT WAS BAL FOR CBNAAT/AFB BUT PATIENT AND PATIENT ATTENDERS ARE NOT WILLING AND WILLING FOR BEING DISCHARGED AND ARE BEING DISCARGED IN HAEMODYNAMICALLY STABLE CONDITION.
Investigation
HEMOGRAM:
6/06/2023
HB:9.7

TLC:18000
PCV: 28.4
PLC:1.89
RBC:2.73
BT: 2MIN
CT:4MIN
PT:14 SEC
APTT:29 SEC
INR:1.0
RBS:562 MG/DL
USG IMPRESSION:
1. B/L RENAL CALCULI
2. GRADE II FATTY LIVER
7/6/2023
HB: 8.5
TLC:13500
PCV:24.7
PLC:1.66
RBC:2.39
FBS:326MG/DL
8/6/2023
HB:9.2
TLC:15500
PCV:26.3
PLC:1.7
RBC:2.46
2D ECHO:
- TRIVIAL TR/ NO MR/AR
- NO RWMA . NO AS / NO MS
- GOOD LV SYSTOLIC FUNCTIONS
-DIASTOLIC DYSFUNCTION(+). NO PAH/PE

CT CHEST:CT IMPRESSION:-THIN WALLED CAVITY IN APICOPOSTERIOR SEGMENTS OF LEFT LUNG UPPER LOBE WITH SURROUNDING CONSOLIDATION- INFECTIVE.- EVIDENCE OF FUNGAL BALL WITHIN THE ABOVE CAVITY - ASPERGILLOMA.- PANCREATIC CALCIFICATIONS CONSISTENT WITH- CHRONIC CALCIFIC PANCREATITIS.
9/6/2023
HB:8.7
TLC:14100
PCV:24.3
PLC:1.57
SPUTUM CULTURE:
NO AFB SEEN
GRAM STAIN:>20 EPITHELIAL CELLS/ LPF , PLENTY OF GRAM POSITIVE COCCI IN PAIRS , SHORT CHAINS, CLUSTERS . FEW GRAM NEGATIVE BACILI SEEEN OCCASIONAL .GRAM POSITIVE BACILLI SEEN .
KLEBSIELLA PNEUMONIA ISOLATED.
SENSITIVE TO GENTAMYCIN, COTRIMOXAZOLE, CIPROFLOXACIN, CEFTAZIDIME, AMIKACIN, CEFEPIME, PIPERACILLIN, TAZOBACTUM, MEROPENEM
RESISTANT TO AMOXY CLAV, CEFUROXIME.
10/6/2023
HB:8.5
TLC:13900
PCV:24.3
PLC:1.55
RBC:2.4
BGT:B POSITIVE
11/6/2023
HB:8.2
TLC:13400
PCV:23.1
PLC:1.71
12/6/2023
HB: 9.6
PCV:27.7

PLC:2.55
RBC:2.72
13/6/2023
HB:8.1
TLC:15100
PCV:23.3
PLC:2.26
RBC:2.29
14/6/2023
HB:8.1
TLC:16200
PCV:23.2
PLC:2.62
RBC:2.31
Treatment Given(Enter only Generic Name)
IV FLUIDS NS,RL @ 75 ML/HR
INJ NEOMOL 1GM IV / SOS
INJ HAI S/C TID
INJ AUGUMENTIN 1.2GM IV BD TILL 8/6/2023
TAB DOLO 650 MG PO/TID
TAB ITRACONAZOLE 200MG PO/TID-D2
TAB OROFER XT PO/OD
TAB LIMCEE PO/OD
TAB COTRIMOXAZOLE PO/BD
SYP GRILLINCTUS DX 2 TSP PO/TID
MONITER VITALS HOURLY
GRBS 7.PROFILE MONITERING
Advice at Discharge
TAB ITRACONAZOLE 200MG PO/BD X 2WEEKS THEN PO/OD
TAB DOLO 650MG PO/SOS X 5 DAYS
TAB OROFER XT PO/OD X 15 DAYS
TAB LIMCEE PO/OD X 15 DAYS
TAB COTRIMAZOLE (800/160) PO/BD X 5 DAYS

TAB PAN 40MG PO/OD/BBF
TAB METFORMIN 500 MG PO/OD ( AFTER FOOD)
SYP GRILLINCTUS DX 10ML PO/TID X 5 DAYS



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