50 year old female with fever ,thrombocytopenia

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CASE PRESENTATION:


A 50 year old female came to casualty  with c/o

Fever since 7 days 


HOPI:

Patient was apparently asymptomatic 7 days back then she developed fever which is  of high grade,intermittent, not  associated with chills and increased during night.2 days later She went to a local hospital where she was diagnosed with typhoid.she was on medication. Her platelets count reduced and fever is not subsided. 

She also complained of mild head ache since 4 days ,relieved on medication 

No h/o nausea, vomiting 

No h/o loose stools/constipation 

No h/o pain abdomen

No h/o Burning micturition 


PAST HISTORY:

Not a K/C/O DM/HTN/ASTHMA/EPILEPSY/CAD/CVA


Personal History :

Diet : mixed
Appetite : Normal 
Sleep : Adequate 
Bowel movements : Regular 
Bladder movements : Regular 

On Examination :

Patient is conscious, coherent and cooperative.
Pallor -Absent
Icterus -Absent
Cyanosis -Absent
Clubbing -Absent
Lymphadenopathy -Absent
Edema -Absent















VITALS :

AT THE TIME OF ADMISSION :
TEMP. : 98.6
PR : 88 BPM
RR : 16 CPM
BP : 100/60 MM HG
SpO2 (on Room air) : 98%
GRBS:108 GM/DL


On Systemic Examination:

CVS : S1, S2 heard
RS : BAE present 
P/A : soft, Non tender

CNS : HMF Intact


INVESTIGATIONS 















On 24/10/22



On 25/10/22

Hb- 11.2 gm/dl
TLC-5,200
Pt count-1.5
RBC-3.86

On 26/10/22

Hb- 11.2 gm/dl
TLC-5,200
Pt count-1.5
RBC-3.86







PROVISIONAL DIAGNOSIS:VIRAL PYREXIA  WITH THROMBOCYTOPENIA 


TREATMENT:

1.IV FLUIDS NS@70 ML /HR

2.TAB.PCM 650 MG/PO/TID 

3.INJ.PAN  40 MG/IVBD

4.INJ.ZOFER 4MG/IV/SOS

5.INJ.NEOMOL 1GM/IV/SOS

6.VITALS MONITORING 


MEDICAL WARD

Day 1(24/10/22)

S:

No fever spikes

O:

Patient is conscious, coherent and co-operative
Temp : 98 F
BP : 100/60 mmHg
PR : 72 BPM
RR : 24 CPM
GRBS:108 GM/DL


A: 
VIRAL PYREXIA WITH THROMBOCYTOPENIA 

P:


1.IV FLUIDS NS@70 ML /HR

2.TAB.PCM 650 MG/PO/TID 

3.INJ.PAN 40 MG/IVBD

4.INJ.ZOFER 4MG/IV/SOS

5.INJ.NEOMOL 1GM/IV/SOS

6.INJ.CEFTRIAXONE 1 GM/IV/BD

7.MONITOR VITALS


MEDICAL WARD

Day 2(25/10/22)

S:

Fever spikes(2 episodes)

Dry cough +


O:

Patient is conscious, coherent and co-operative
Temp : 99 F
BP : 120/70 mmHg
PR : 84 BPM
RR : 22 CPM
GRBS:124 GM/DL


A: 
VIRAL PYREXIA WITH THROMBOCYTOPENIA 

P:


1.IV FLUIDS NS@70 ML /HR

2.TAB.PCM 650 MG/PO/TID 

3.INJ.PAN 40 MG/IVBD

4.INJ.ZOFER 4MG/IV/SOS

5.INJ.NEOMOL 1GM/IV/SOS

6.INJ.CEFTRIAXONE 1 GM/IV/BD

7.SYP.BENADRYL 10 ML/PO/TID

8.TAB.DOXY 100 MG PO/BD

9.INJ.FALCIGO 120 MG AT 11 AM, 11 PM AND 11 AM

10. MONITOR VITALS 


AMC CUBICLE 2

Day 3(26/10/22)

S:

Fever spikes


O:

Patient is conscious, coherent and co-operative
Temp : 102 F
BP : 110/70 mmHg
PR : 98 BPM
RR : 18 CPM
GRBS:124 GM/DL


A: 
VIRAL PYREXIA WITH THROMBOCYTOPENIA (resolved)

P:


1.IV FLUIDS NS@100 ML /HR

2.TAB.PCM 650 MG/PO/QID 

4.INJ.PAN 40 MG/IV/OD

5.INJ.NEOMOL 1GM/IV/SOS(if temp>101F)

6.SYP.BENADRYL 10 ML/PO/TID

7.TAB.DOXY 100 MG PO/BD

8.INJ.FALCIGO 120 MG AT 11 AM

9. MONITOR VITALS 


AMC CUBICLE 2

Day 4(27/10/22)

S:

Fever spike@ 4 am

Cough @night 


O:

Patient is conscious, coherent and co-operative
Temp : 102 F
BP : 120/70 mmHg
PR : 69 BPM
RR : 18 CPM
RS-BAE+
CVS -S1S2+
CNS-NO FND


A: 
VIRAL PYREXIA WITH THROMBOCYTOPENIA (resolved)

P:


1.IV FLUIDS NS@100 ML /HR

2.TAB.PCM 650 MG/PO/QID 

4.INJ.PAN 40 MG/IV/OD

5.INJ.NEOMOL 1GM/IV/SOS(if temp>101F)

6.SYP.BENADRYL 10 ML/PO/TID

7. MONITOR VITALS 





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