72y female with fever since 36 days

This is an online E logbook to discuss our patient’s de-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 patients' clinical problems with collective current best evidence-based inputs.

Chief complaints: 

Fever since 1month (sep15th)

Burning micturition for 10days (sep15th -25th)

Abdominal pain since 1month 

Decreased appetite since 20 days

HISTORY OF PRESENTING ILLNESS:

A 72 year post menopausal female , came to casualty with complaints of fever since sep15th ( 36th day of illness). Fever was high grade with evening rise in temperature associated with chills and rigors, not associated with nausea and vomiting/headache/cold/cough . She was treated with oral medicines on day 2 of illness,But fever dint subside . Not associated with loose stools /blood in stools

On 2nd October presented to outside hospital  after talking to the previous consultant  he said,she presented with fever , right hypochrondiac pain and nausea , she was clinically as SEPSIS WITH MODS, surgical opinion was taken and adviced for lap cholecystectomy for acalculous cholecystitis, but they refused.,  advised to get CECT abdomen but she got chills after a test dose of contrast. The physician thought of melioidosis and started on Meropenem itseems.  Blood and urine cultures were not done (17th day of illness ) she was given IV antibiotics for 2 days , and was on antipyretics

From 9th October she had feverspike , she consulted a doctor, she was started on inj. Magnexforte and Tab. Farepeneum 200mg for a week. 

On 19/10/22, they are referred to our hospital.

PAST HISTORY:

K/c/o Hypertension since 20yrs and was on Amlodipine 5mg + atenolol 50mg 

K/c/o Type 2 diabetes mellitus since 22 yrs and is on Tab. Glimepiride 2mg+Tab. Met Formin 500mg

Surgery: Right PFN 11yrs ago

PERSONAL HISTORY:

Decreased appetite takes mixed diet, irregular bowels( Type 1 Bristol stool) ,normal micturition , no allergies 

Family history: not significant 

 MENSTRUAL HISTORY: 

Age of menarche - 15yrs

LMP- post menopausal status

OBSTETRIC HISTORY:

Age at marriage-12yrs

Gravida 3 (all 3 are Full term NVD)

1st male , 2nd female - died

3rd - female alive 

GENERAL PHYSICAL EXAMINATION 

Patient conscious coherent cooperative 

Moderately built and nourished

 pallor present

No icterus, cyanosis, clubbing, lymphadenopathy 

Pedal edema upto lower end of tibia  now resolved


 Vitals

Bp:160/90mmhg

RR-21cpm

PR-98bpm

SPO2-94%

GRBS-343mg/dl (inj. HAI 12 units given)

TEMP-98.3F

 SYSTEMIC EXAMINATION:

CVS:  S1 S 2Heard

RS: SOB GRADE 2 MMRC, vesicular breath sounds

PER ABDOMEN: scaphoid, nontender, BS +

CNS: NFND.

DIAGNOSIS:

PYREXIA OF UNKNOWN ORIGIN

 INVESTIGATIONS:

Chest x ray pa view22/10/22



 2 d echo
MRI
 pleural tap done on 22/10/22
 Pateint and patient attenders denied. BAL
TREATMENT:

Day 1:

  1. Allow oral fluids
  2. INJ. NEOMOL 1gm/iv/sos
  3. TAB. Dolo 650mg/po/TID
  4. Vital monitoring 1 hourly
  5. Tab. AMLODIPINE 5mg + ATENOLOL 50mg /po/od
  6. INJ. HAI 
  7. 7 points GRBS Profile

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