A 26 YEAR OLD MALE WITH ? FEVER UNDER EVALUATION WITH AKI,ALI WITH SEVERE THROMBOCYTOPENIA

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A 26 year old male farmer by occupation came with chief complaints of 

Fever since 7 days

Pedal edema since 7 days

Loss of appetite since 5 days

HOPI - Patient was apparently asymptomatic 1 week back ,then he had one episode of low grade fever,relieved with medication,associated with generalised body pains ,not associated with cough, burning micturition.

Then developed pedal edema ,intially till ankle , gradually progressive ,pitting type.

C/o loss of appetite since 4-5 days associated with nausea .

H/o of one episode of vomiting 4 days back which is non bilious ,non projectile,food particles as content.

Past history -H/o Rat bite present 4 - 5 months back

Not a k/c/o DM/HTN/ Thyroid

Personal History

Marital history- Married

Occupation - Farmer

Diet - Mixed

Bowel & Bladder movements - Regular

Addiction- Takes alcohol occasionally 

Vitals:

Temperature - 98.7F

PR-90bpm

RR-24cpm

BP- 100/60

SpO2 - 97% at Room air 

Fever chart

No pallor/ cyanosis//clubbing/lymphadenopathy

Icterus +

Edema of feet+

 

CVS - S1,S2 +,no murmurs

RS - BAE Present,NVBS

P/A - soft ,BS +

CNS-PT CONSCIOUS,SPEECH NORMAL

CRANIAL NERVES-NORMAL

REFLEXES-

                        RT.     LFT

BICEPS-.       1+      1+

TRICEPS-.     1+     1+

SUPINATOR- 1+     1+

ANKLE.         1+       1+

KNEE-            1+      1+

Investigation

2D ECHO

ECG 24/2/22

ECG 25/2/22

ECG 26/2/22

ECG 27/2/22

USG

X - ray

HB - 20.4->20.6->19.9->20->22.3->21.6

TLC- 17,700->12,800->9640->7800->9300->8700

PLC-

60,000->35,000->46000->71000->1.10->1.50

Serum urea

129->134->104->78->59->46

Serum creatinine

4.9->4.2->2.9->2->1.5->1.2

TB

4.64->4.43->3.7->2.41->3.12

DB

3.68->2.10->1.4->1.66->1.34

Provisional diagnosis-   ? LEPTOSPIROSIS WITH SEVERE THROMBOCYTOPENIA ? SINUS SICK SYNDROME

Treatment

1. IV fluids NS ,RL@ 100 ml / hour

2. Inj . Doxycycline 100mg IV/BD

3.Inj. Pan 40 mg IV /OD

4.Inj. Optineuron 1 ampoule in 100ml NS IV /OD

5. TAB .PCM 500 mg PO / SOS

6.BP/PR/TEMP 4 th hourly