42YR MAN HAVING FEVER WITH RASH

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

Here is a case I have seen : 
Unit 3 :
Case admitted in AMC on 27/01/21
Interns-
Harsha
Sreeja
Archana
Kalyan
Sahithi
Jeeharika

Dr Raveen - PGY1
Dr Aashitha - PGY2
Dr Aravind - PGY3
Dr Vamshi - PGY3
Dr Hareen - SR
Dr Praveen Naik - Asst. Prof

Introduction:
Fever with rash is a common presentation which poses a challenge in daily clinical practice. It is often said that the eyes do not see what the mind does not know. A detailed history and systematic clinical examination often provides clinical clues to the diagnosis in a clinically unsuspecting case. The temporal association of rash with fever, its characteristics, distribution, hemorrhages and associated arthralgias or organomegaly often clinches the diagnosis.
Here we present a case of a 42 year old man who presented to us with fever and rash.

42 year old man presented to the OPD with the complaints of:
Fever since 7 days
Rash on bilateral forearms since 4 days
Burning micturation since 4 days
Pain abdomen since 4 days

Patient works as a Driver, he resides at a local village. He had no previous medical issues until 7 days back when he developed fever, which was of  sudden onset and was associated with chills. He describes the fever to be a continuous one. He took Paracetamol which relieved his fever. After 4 days of onset of his fever, he developed rash on both his extensor aspect of his forearms which was associated with moderate itching. He even experienced burning micturation along with pain abdomen.
He now, has been having fever with chills since 2 days along with burning micturation and pain abdomen. He also says that he has been having myalgias since morning.

The patient gives no previous similar history, no significant history of exposure to food, toxins.
No recent travel history.


On examination :

Patient is an obese individual
With no pallor, Icterus, cyanosis, clubbing, lymphadenopathy, pedal edema
PR- 84 bpm
BP-100/80 mmHg
RR-18 cpm
Temperature -99.4 F
SPO2-98% @room air
GRBS-100 mg/dl

Erythematous maculopapular lesion on his bilateral forearm, on his extensor aspect

Cvs - S1, S2+
Lungs were clear on auscultation
Per Abdomen -
Tenderness + in Left lumbar region
Bowel sounds +

Fever charting :


Chest X Ray PA view

ECG


Serology :
USG Abdomen


Diagnosis :
Fever under evaluation

Treatment:
IVF 2 NS @75ml/hour
Tab.PCM 650mg PO TID
Tab.Doxy 100mg PO BD
Temperature charting 4th hourly

28/1/21
S: No fresh complaints

O: patient is conscious, coherent, cooperative, oriented to time place person
PR: 84 bpm, regular
Bp: 110/80 mm hg
Temp: 99 degree Fahrenheit
CVS:s1 s2 heard, R/S: Bae present
Per abd: soft, non tender

A: Fever under evaluation
Peripheral eruptions under eruptions

P: Tab Doxycycline 150 mg /PO/BD
Tab Dolo  650 mg /Po/TID
Inj. Neomol 100 ml/IV/ if temperature more than 101 degree Fahrenheit
Temp. Charting
Monitoring vitals

29/1/21

S: Fever spikes decreased 
No fresh complaints 

O: BP-130/60mmhg
PR-80bpm
Cvs-s1s2 +
Rs-Nvbs+
P/a-soft non tender 

A: Fever under evaluation

P:IV NS @75ml/hr 
Tab dolo 650mg po sos 
Tab pantop 40mg od before breakfast
Inj ceftriaxone 1gm IV bd
Inj neomol 100ml IV sos
Tepid sponging
Plenty of oral fluids
BP, PR 8th hourly monitoring

30/01/21

S: no Fever spikes after 5pm
No fresh complaints 

O:
Bp-130/80mmhg
PR-84bpm
Cvs-s1s2 +
Rs-Nvbs+
P/a-soft non tender 

A: Pyrexia under evaluation with cholelithiasis
 
P:
IV NS @75ml/hr 
Tab dolo 650mg po sos 
Tab pantop 40mg od before breakfast
Inj ceftriaxone 1gm IV bd
Inj neomol 100ml IV sos
Tepid sponging
Plenty of oral fluids
Bp, PR 8th hourly monitoring

31/1/21

S-
Fever spikes decreased 
No fresh complaints 

O-
Bp-130/90mmhg
PR-86bpm
Cvs-s1s2 +
Rs-Nvbs+
P/a-soft non tender 

A-
Pyrexia with rash

P-
Tab Taxim 200mg BD
Tab dolo 650mg po sos 
Tab pantop 40mg od before breakfast
Inj.NEOMOL 100ml IV if temp >101F
Tepid sponging
Plenty of oral fluids
Bp, PR,Temp 4th hourly monitoring

01/02/21

S-Fever spikes decreased 
    No fresh complaints 

O -
Bp-130/80mmhg
PR-84bpm
Cvs-s1s2 +
Rs-Nvbs+
P/a-soft non tender 

A-Typhoid fever 

P-
Planned for discharge today
Discharged .

Discussion

A surgery opinion was taken for his Choleliathiasis and was suggested that he didn't need any active surgical intervention of now

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