54 year old female

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CHEIF COMPLAINS 

C/o fever since 10days

C/o generalised weakness since 10days

HOPI:

Pt was apparently asymptomatic 12days ago later she noticed swelling in right axilla associated with pus discharge then she developed fever 10days ago which is insidious in onset intermittent associated with chills and rigors and given symptomatic treatment in home for 3days 

As fever was not relieving she was taken to miryalaguda hspl there she was given treatment for typhoid and antibiotics were given and she was on those medication for 5days but Fever has not subsided then she came to our hospital yesterday night

No h/o cold and cough 

No h/o nausea and vomiting

No h/o abdominal pain,loose stools

No h/o burning micturition 

PAST HISTORY 

No similar complaints in the past.

No comorbidities.

PERSONAL HISTORY 

Consumes mixed diet 

Appetite reduced

Bowel n bladder regular 

Sleep adequate 

No addictions

VITALS

BP-120/80 mm of Hg

PR-67/min

RR-20/min

afebrile

SYSTEMIC EXAMINATION 

CVS:S1S2 heard 

Jvp not raised

No murmurs heard

RESPIRATORY: BAE+, clear

ABDOMEN: Soft, non tender, BS+, no organomegaly.

CNS: NFND.

Course in the hospital 

A 54-year female clinically presented to the causality with the above-mentioned complaints. Upon admission, necessary investigations were done. Her initial workup showed Hb 13.1 gm/dl; TLC 8600 cells/mm³; platelet count 1 lakhs/mm³. She had a lesion over the right infra axillary region for which use was advised. She had postural drop for which intravenous fluid resuscitation and replacement with meticulous monitoring was done. 

2D ECHO was done on 15/9/22 which showed evidence of :

Good LV systolic function with Ejection fraction of 60% ; No RWMA; No MS or AS; Trivial TR and AR; No MR; Minimal pericardial effusion; Diastolic dysfunction was present;  IVC size of 1.3 cms; No LV clots.

On 16/09/2022 her Hb was 14.6 gm/dl; TLC 9900 cells/mm³; platelet count 1 lakhs/mm³.

On16/09/22 ultrasound breast and axilla was done which showed Right axillary lymphadenopathy and Focal subcutaneous edema in right axilla- likely infective 

 On 17/09/2022 her Hb was 13.2 gm/dl 

TLC 10,300 cells/mm³.platelet count 40,000 lakhs/mm³. She has been advised to have plenty of oral fluids. She was tolerating feeds well but has residual symptoms like nausea, generalised weakness and decreased appetite. During the stay in hospital she was treated with IV Fluids, Antibiotics, Antipyretics and supportive medications . On 18:09/2022 her Hb was 13.3 gm/dl, TLC 10,400 cells/mm³, platelet count 1.93 lakhs/mm³. Her condition was gradually improved and discharged in a stable condition.

INVESTIGATIONS 

2D ECHO was done on 15/9/22 which showed evidence of :

Good LV systolic function with Ejection fraction of 60% ; No RWMA; No MS or AS; Trivial TR and AR; No MR; Minimal pericardial effusion; Diastolic dysfunction was present;  IVC size of 1.3 cms; No LV clots.

USG BREAST &AXILLA

-Right axillary lymphadenopathy 

-Focal subcutaneous edema in right axilla- likely infective 

PROVISINAL DIAGNOSIS 

Viral pyrexia with thrombocytopenia

Denovo DM2

TREATMENT 

1. IVF NS/RL @75ML/HOUR 

2. INJ. NEOMOL 100ML /IV/SOS 

3. TAB. DOLO 650MG/PO/QID.

4.OPTINEURON 1AMP in 100 ml /NS/IV/OD

5.TAB LIMCEE50mg/PO/OD

6.tab.DOXY 100 mg BD

7.INJ.MONOCEF1gm/IV/BD 

8.TAB. METFORMIN 500mg /PO/OD 

9.temperature and vital monitoring