Staff Round: Ward 32 Prof. N. Gupta Unit

STAFF ROUND
WARD 32
Prof. N. Gupta Unit
CASE - 1
Patient Ms. R, 20 year/F, resident of Delhi,
presented with c/o
 Fever 6 days
 Chest pain 5 days
 Shortness of breath 5 days
 Palpitations 2 days
HISTORY (Cont.)
No h/o
• cough, expectoration, sore throat.
• syncope, presyncope, joint swelling.
• vomiting, diarrhoea, pain abdomen.
• swelling of limbs, burning micturation.
No h/o
• exposure to drugs, radiation,toxins,tick.
• chest trauma, TB, HT, DM.
EXAMINATION
 GPE
o Patient conscious, oriented, temp. 1040F.
o PR- 130/min, BP- 90/60 mm Hg, RR- 28/min.
o Pallor present.
o No icterus, cyanosis, clubbing, pedal edema.
o JVP not raised. No thyromegaly or LAP.
 CHEST : B/L basal crackles.
 CVS, CNS, ABDOMEN : WNL.
INVESTIGATIONS
 CBC :Hb 8.5, TPC 78000, TLC 5800
 LFT, KFT : WNL
 CXR : WNL
 ECG :
 P/S for MP : Negative
 URINE -R/M : WNL
- C/S : No growth
 BLOOD C/S : Sterile
INVESTIGATIONS(Cont.)
 CPK :27 U/L
 TROPONIN –T : Negative
 OPTIMAL : Positive for plasmodium vivax
 ECHO : Mild MR, TR, minimal PE.
: jerky septal wall movement
:LV systolic dysfunction, EF 40%

s/o myocarditis.
MANAGEMENT & COURSE
 Bed rest, O2, Antipyretics, Tab. Chloroquine.
 Monitored clinically and with ECG, CPK.
 Patient improved and became asymptomatic.
 Repeat ECHO : LVEF 50%
 Serology for : COXSACKIE, ADENO, PARVO,
HIV, HCV : Negative.
 CMRI :
FINAL DIAGNOSIS
CASE - 2
Patient A, 15yr/M, resident of Delhi,
presented with c/o
 Fever 6 days
 Yellowish discolouration of sclera 3 days
 Abdominal pain 2 days
HISTORY (Cont.)
No h/o
• vomiting, abdominal distention, g.i. Bleed.
• diarrhoea, clay coloured stool, pruritus.
• cough, expectoration, chest pain, dyspnoea.
• burning micturation, soft tissue swelling, rashes.
• bone pain, joint pains, ear discharge, trauma .
No past h/o
• blood transfusion, jaundice, tuberculosis,DM.
• cardiovascular disease, haematological disorder.
EXAMINATION
 GPE
o Patient conscious, oriented, temp101.40F.
o PR 104/min, BP 120/70mmHg, RR 16/min.
o Icterus ++
o No pallor, cyanosis, clubbing or LAP. JVP N.
o No skin, nail, bone or joint abnormalities .
 ABDOMEN : 2 cm splenomegaly.
 RESP. SYSTEM, CVS, CNS : WNL
INVESTIGATIONS
 CBC : Hb-10.4, TPC- 46000, TLC-6500, Retic.Count-3.6%
 LFT : T.Bil-4.8, D. Bil-0.9, AST-25, ALT-27
 KFT, CXR, ECG : WNL
 P/S for MP : Negative
 LDH : 1334 U/L
 URINE C/S : No growth
 BLOOD C/S :Sterile
 OPTIMAL : +ve for plasmodium vivax.
 HBsAg, Anti HCV : negative.
INVESTIGATIONS (Cont.)
 USG Abdomen : Splenic abcess 2.8*1.7 cms.
 CECT Abdomen : Splenic abcess 3.1*1.8 cms.
No other septic foci in abdomen and pelvis.
 ECHO : No e/o infective endocarditis.
 ANA, RF, HIV :
 Splenic aspirate :
MANAGEMENT & COURSE
• Inj.Artisunate, Pantoprazole, Ceftriaxone ,
Tab. Doxycycline, Folic acid, Primaquine.
• Symptomatic improvement .
• TPC and LFT recovered.
• Repeat USG shows decrease in abcess size.
FINAL DIAGNOSIS
CASE - 3
Patient Mrs. S, 55year/F, resident of UP,
presented to surgery em. with c/o
 Fever : 7 days
 Pain abdomen : 4 days
 Vomitting : 4 days
 Yellowish discolouration sclera :3 days
HISTORY ( Cont.)
No h/o
• Abdominal distention, g.i. Bleed.
• Diarrhoea, constipation.
• Pruritus, clay coloured stool, trauma, burn.
• Cough, expectoration, chest pain, dyspnoea.

• Burning micturation, altered sensorium.
No h/o
• DM, HT, CVA, CAD, TB, Cholelithiasis, Alcohol.
• Jaundice, blood transfusion in past.
EXAMINATION
 GPE
o Conscious, oriented, temp.1030F,BMI-24kg/m2
o PR 110/min, BP 108/76mm Hg, RR 18/min
o Icterus ++
o No pallor, cyanosis, clubbing, PE or LAP. JVP N.
 ABDOMEN :Rt.Hypochondrial tenderness
Hepatosplenomegaly ++
 CHEST, CVS, CNS : WNL
INVESTIGATIONS
 CBC: Hb-12.3, TLC-8400, TPC-26000
Retic. count 3.4%
 LFT : T.Bil-13.1, D.Bil-2.7, AST-45,ALT-32
 KFT
 CXR WNL
 ECG
 Amylase : 46 U/L
 P/S for MP : Ring and gametocytes of P. vivax
 LDH : 784 U/L
INVESTIGATION (Cont.)
 USG Abdomen :
Liver 15cm, fatty change, no SOL/IHBD
dilatation, Spleen 15.2cm.GB thickened,
edematous (wall thickness 12mm) with
pericholecystic edema, No e/o calculi.
 Blood C/S : Sterile
 Urine C/S : No growth
 HBsAg, Anti HCV : Non Reactive
MANAGEMENT & COURSE
• IV fluids, Inj. Pantoprazole, inj. Perinorm.
• Tab. Quinine and Doxycycline.
• Symptomatic improvement.
• TPC and LFT recovered.
• Repeat USG Abdomen : resolution of
pericholecystic collections and decrease in
wall thickness.
FINAL DIAGNOSIS

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STAFF ROUND

:LV systolic dysfunction, EF 40%

• Cough, expectoration, chest pain, dyspnoea.

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