A 70 year old female presented to Casuality with C/o fever since 6 days, abdominal pain since 4 days, pain and swelling of Lt LL since 4 days.She was referred to GM I/V/o fever, nausea and B/l pitting edema.

HOPI:

Pt C/o fever since 6 days which is continuous associated with chills and rigors, relieved on medication, no diurnal variation, not ass with cold, cough, burning micturition.

C/o pain abdomen which is insidious in onset gradually progressive with no aggravating and relieving factors, squeezing type of pain associated with nausea.

No H/o vomitings.

Also Pt C/o pain over Lt LL associated with Itching and swelling which is insidious in onset and gradually progressive.

Past History 

K/c/o HTN since 10 years( not on regular medication)

K/c/o filariasis to Lt LL since 45 years

N/k/c/o DM2, TB, Epilepsy,CAD,CVA, Hypothyroid.

O/E

Pt is oriented to person

Not oriented to time and place

BP: 90/60 mmhg

PR: 96bpm

PR: 20 cpm

CVS: S1 S2 +

RS: NVBS+ BLAE+

CNS: NFND

P/A: Diffuse Tenderness Present

Clinical Images:

Fever Chart-











Investigations



Provisional Diagnosis:


Altered sensorium secondary to  ?septic encephalopathy ?Uraemic encephalopathy ?Hypoglycaemia (resolved) with ulcer over anterior aspect of left LL secondary to filariasis with k/c/o HTN since 10 years

4 sessions Dialysis done


Treatment:


1.INJ LASIX 40 mg IV/BD

2.Ryles feed 200 ml water 2nd hrly ; 200ml milk with protein powder 4th hrly. 

3.INJ PAN 40 mg IV/OD

4.INJ Levofloxacin 750mg IV/OD

5.TAB. DIETHYL CARBAMAZINE 100mg RT/BD

6.INJ. Augmentin 1.2gm IV/BD

7.INJ Piptaz 2.25 IV/TID

8.T. Ecospirin AV 75/10 mg RT/HS

9.IV Fluids @ 50 ml/hr



[06/09/23, 9:46:48 AM] Rakesh Biswas Sir: Ulcer secondary to filariasis? 🧐


[06/09/23, 9:49:23 AM] Rakesh Biswas Sir: 45 year old Filariasis being treated now with Ryle's tube diethyl carbamazine!


[06/09/23, 11:24:48 AM] Cherish Kandru: Yes sir


[06/09/23, 11:25:02 AM] Cherish Kandru: Yes sir


[06/09/23, 1:30:33 PM] Rakesh Biswas Sir: Has this been reported in the literature earlier?


[06/09/23, 1:30:44 PM] Rakesh Biswas Sir: Has this been reported in the literature earlier?


[07/09/23, 7:40:52 AM] Cherish Kandru: Sir I couldn’t find any literature on either of them sir

[07/09/23, 8:07:26 AM] Rakesh Biswas Sir: See you discovered something new and this is your bloom level 6 moment!

[07/09/23, 8:19:54 AM] Cherish Kandru: 😅yes sir

Link to the PaJR group

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