A 57 year old female with fever and generalized weakness

MEDICINE CASE

A 57 YEAR OLD LADY WITH FEVER AND GENERALIZED WEAKNESS

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A 57 year old female came to our casuality with chief complaints of fever and generalized weakness since 3 days.

History of present illness-

Patient was apparently asymptomatic 3 days back,then he developed fever which was high grade associated with chills which was decreased with medication.

Generalized weakness and body pains since 3 days,

No other complaints,

No history of pain abdomen,vomitings and decreased urine output.

Past history-Not a k/c/o diabetes, hypertension,asthma,epilepsy,cva,cad

4 years back,patient developed high grade fever, associated with chills and rigors,vomitings 6 episodes generalized weakness,body pains with bp 100/70 ,and diagnosed with viral pyrexia with septic shock,with aki,with hepatopathy with thrombocytopenia and was treated with,

Inj .meropenen 1 gm/IV/bd

Inj.difidox 100 mg/IV/bd

Inj.falcigo,inj .pan,inj .optineuron,inj .lasix,inj norad,tab.hepatogon,tab.udiliv,tab.dolo,patient was treated conservatively and discharged with supportive medications,

Menstrual history-

she had menstrual abnormalities since the age of 35 years she is amenorrhoeic.

On examination-

Temp-afebrile,

Pr-98/min

Rr-18/min

Bp-100/60 mm hg

Systemic examination-

Cvs-s1,s 2 heard

No added sounds,no murmurs.

Resp-BAE +,NVBS heard

Per abdomen-soft,non tender,NAD

Cns-nfnd

Investigations-

Haemogram-12/9/21-

LFT-

Cxr - pa view 

Rapid hbs Ag- negative

Rapid hiv 1&2 - negative

Rapid anti-hcv antibodies - negative

Rapid dengue - negative

13/9/21-

Haemogram-

Hb-5.2

Pcv-13.7

Rbc-1.70

Plt-50,000

Tlc-8500

Neutrophils-15

Lymphocytes-76

Eosinophils-1

Monocytes-8

Basophils-0

Mcv-80.6

Mch-30.6

Mchc-38.0

Rft-

Serum creatinine-1.5

Blood urea-38

Serum electrolytes-sodium-130,potassium-4.3,chloride-98

Esr-165 mm

Reticulocyte count-0.7

Serum osmolality-277

Ldh-403

Blood group-  O +ve

Prothrombin time-15

Inr-1.11

Aptt-31

Bt-2:30 min

Ct-3:00 min

Iron studies-

Iron-158 ug/dl

TIBC-436ug/dl

Transferrin saturation-36.2%

Transferrin- 297ug/dl

Peripheral smear-

cue-

Ultrasound abdomen

Ecg-

On 14/9/21-

Haemogram-

On15/9/21-

Haemogram-

On 16/9/21-

Haemogram-

Urine electrolytes- 

Serum electrolytes-

Provisional diagnosis-Viral pyrexia with thrombocytopenia with relative lymphocytosis secondary to infections with aki with anaemia under evaluation.

Treatment given- 

Day 1

No IV fluids,

Oral fluids-3L/day

Tab.pan 40 mg/IV/od 

Inj.optineuron 1 amp in 100 ml NS/IV/od.

Day 2:

No IV fluids

Oral fluids-3 L/day

Tab.pan 40 mg/IV/od

Tab.zincovit po/od

PAST COURSE IN HOSPITAL IN 2019:

Discharge summary-

On 19/8/19

Thyroid profile

  2d echo

CBP-

RFT-

culture and sensitivity(routine)

LFT-

Immunology and serology-

Ultrasound abdomen-

CT brain plain

Blood group- O +ve

Esr-35 mm at the end of 1st hour.

Serology-HIV,Hbs Ag,HCV Negative.

Dengue-IgG,IgM,NS1 - negative

Malarial parasites- Negative

Rbs-81 mg/dl

PT and APTT-

CUE-

ECG-

Death summary-

This is a case of 57 year old female with febrile neutropenia with pancytopenia with septic shock.

The patient was admitted on 12/9/21 and treatment started conservatively and on 15/9/21,patient became drowsy and on evaluation and found to have hyponatremia and bone marrow biopsy was done on 16/9/21 at 4 pm and after that she was started on prophylactic antibiotics and at around 1 pm in the night time she is hypoglycemic with hypotension.In view of decreasing SPO2 patient was intubated ,with absent central pulses,cpr was initiated and was done according to 2015 AHA guidelines.

Inspite of all efforts,patient could not be revived and declared dead on 3:41 am on 17/9/21

Her bone marrow biopsy revealed-