A 30 year old female completed her degree final year came with complaints of fever since 2 month’s and cough with sputum since 15 days.
HOPI:
Patient was apparently asymptomatic 2 months back and then she developed fever which was insidious in onset,,high grade and not associated with chills and rigors and relieved on taking medication and again after one week she again developed fever which is of high grade and 15days back patient developed cough associated with sputum.And her sputum is scanty in amount, white in colour,no blood in sputum and non foul smelling sputum.And patient developed shortness of breath which is present only at nights not disturbing her sleep and she had known about it after her attenders noticed it.SOB at nights only since15 days which is on and off and 15days.
No loss of Apetite,No weight loss in last 2 months.
Not a known case of DM,HTN ,TB, ASTHMA, CAD and CVA.
Attendend a weight loss programme for which she lost 7kgs in last 7 mnths.
Her weight now 66kgs.
GENERAL EXAMINATION:
No pallor,Icterus,Cyanosis,Clubbing,Koilonychia,Lymphadenopathy and edema.
JVP:No raise
Systematic examination:
Bp:130/80mmHg in right arm in sitting posture on day 1
100/60mmhg in right arm in sitting posture on day 6
PR:120bpm,regular rhythm,normal volume
CVS:S1 and S2 are heard
Decreased heart sounds
CNS:NAD
RS:18cpm
BAE present
Air entry decreased in right side
Right infrascapular wheeze and right infraaxillary wheeze and left Infrascapular crepts are present.
Temperature:Afebrile at time of presentation
Mantoux test:Done outside shows positive reaction.
CB NAAT of sputum:Shows negative for AFB
INVESTIGATIONS:
Chest x ray and CT chest done on 17 june outside
Chest x ray done on 23 june 2022
Renal Function Tests:
Test | Result |
Urea | 19 mg/dL |
Creatinine | 0.7 mg/dL |
Uric acid | 3.0 mg/dL |
Calcium | 10.1 mg/dL |
Phosphorous | 4.1 g/dL |
Sodium | 134 mEq/L |
Potassium | 3.8 mEq/L |
Chloride | 100 mEq/L |
Liver Function Tests:
Test | Result |
Total Bilurubin | # 1 20 mg/dL |
Direct Bilurubin | # 0 31 mg/dL |
SGOT(AST) | # 45 IU/L |
SGPT(ALT) | 27 IU/L |
ALKALINE PHOSPHATE | # 198 IU/L |
TOTAL PROTEINS | 80 gm/dL |
ALBUMIN | # 3.19 gm/dL |
AIG RATIO | 66 |
Hemogram:
Test | Result |
Hemoglobin | 8.5 gm/dL |
Total Count | 7100 cells/cu. mm |
Neutrophils | 66% |
Lymphocytes | 22% |
Eosinophils | 2% |
Monocytes | 10% |
Basophils | 0% |
PCV | 27.2 vol % |
MCV | 72.5 fl |
MCH | 22.5 pg |
MCHC | 31.3% |
RBC Count | 3.72 millions/ cu. mm |
Platelet Count | 3.64 lakhs/cu. mm |
Complete Urine Examination:
Test | Result |
Colour | Pale Yellow |
Appearance | Clear |
Reaction | Acidic |
Sp. Gravity | 1.010 |
Albumin | Nil |
Sugar | Nil |
Bile Salts | Nil |
Bile Pigments | Nil |
Pus Cells | 2 - 3 |
Epithelial Cells | 2 - 3 |
Red Blood Cells | Nil |
Crystals | Nil |
Casts | Nil |
Amorphous Deposits | Absent |
Others | Nil |
Pericardial Fluid:
Test | Result |
V | 0.5 ml |
APP | Clear |
COI | Reddish |
TC | 1000 cells |
DC | 90% L + 10% N |
RBC | 6 lakhs |
Others | Nil |
Blood Sugar:
Test | Result |
Random Blood Sugar | 209 mg/dL |
Post Lunch Blood Sugar | 179 mg/dL |
Glycated Hemoglobin:
Pericardial fluid ADA levels raised :61
Pericardial fluid for CB NAAT:No AFB and no sensitivity for rifampicin,
PROVISIONAL DIAGNOSIS:
pericardial effusion secondary to TB.
Treatment Given:
1. NEB BUDECORT 1 RESPULE / 6TH HOURLY
2. TAB DOLO 650 MG / TID
3. TAB RIFAMPICIN 150 MG GIVEN FOR 2 DAYS
4. TAB ISONIAZID 75 MG
5. TAB PYRAZINAMIDE 400 MG
6. TAB ETHABUTOL 275 MG
7. TAB WYSOLONE 20 MG BD GIVEN FOR 2 DAYS
8. TAB BENADON OD
9. PROTEIN POWDER - 2 SCOOPS IN 1 GLASS OF MILK TID
Advice at Dishcharge:
1. NEB BUDECORT 1 RESPULE / 6TH HOURLY
2. TAB DOLO 650 MG / TID
3. TAB RIFAMPICIN 150 MG
4. TAB ISONIAZID 75 MG
5. TAB PYRAZINAMIDE 400 MG
6. TAB ETHABUTOL 275 MG
7. TAB WYSOLONE 20 MG BD FOR 1 DAY, OD FOR 3 DAYS
8. TAB BENADON OD
9. PROTEIN POWDER - 2 SCOOPS IN 1 GLASS OF MILK TID
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