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



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