42YR MAN HAVING FEVER WITH RASH

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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