66 Year old male patient with fever since 10 days.

13th June 2023
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A 66 year old male came with the following
    
Chief complaints:

• Fever associated with chills and rigors since 10 days

• shortness of breath at rest
• Pain in the right flank.

         
HISTORY OF PRESENTING ILLNESS :

Patient was apparently asymptomatic 2 months ago,  then he developed fever

which was insidious in onset and gradually progressive, aggravated by the intake of food.

He began noticing an increase in temperature after eating food,

especially at nights, which used to subsequently relieve on medication at times.

Patient complained of having high grade fever which was continuous and

associated with chills and rigor since 10 days.

Additionally, he suffered from loose stools 15 days ago,

not associated with constipation, obstipation, vomiting. burning micturition. 
Further, he also complained of pain in the right upper quadrant of abdomen,

intermittent and insidious in onset and gradually progressive, non radiating

and pricking type, aggravated at night time. Patient also complained of shortness of breath since 5 days whenever he walked fast or up a slope, (MMRC grade 1) since 2 months, not associated with wheeze. no aggravating or relieving factors. Gradually progressing to shortness of breath where he has to stop for breath in between work (MMRC grade 2), not associated with orthopnea, PND. chest pain, cough, chest tightness, hemoptysis.

Patient also complained of shortness of breath since 5 days,

(MMRC grade 1) since 2 months not associated with wheezing.

 

PAST HISTORY

Not a known case of diabetes, TB,epilepsy, Asthma, HTN

No similar complaints in the past.

No known allergies.

FAMILY HISTORY

Family history positive for Diabetes

PERSONAL HISTORY :

Daily Routine

Patient wakes up at 5 A.M, and smokes numerous beedis, ashe feels that he cannot defecate until he does.

He then heads to work, where he smokes more beedis.

At 6:30 A.M. he gets off from work and then proceeds to completeall his morning ablutions like brushing teeth, going to the restroom,followed by breakfast, a cup of tea and further smoking a full packet of beedis. 

He then returns to work, which he briefly resumes for half an hour,owing to lunch break from 2pm to 2:30 pm.

At 5 pm, he is finished with work for the day and rests for an hour, from 6pm to 7pm.After waking up at 7pm, he continues to consume 90mL of alcohol (whiskey) ,along with dinner upon his discretion, depending on whether he is feeling up to itor not on that particular day, especially considering the fact thathe kept experiencing fever every time he ate at night time. The patient notablyexpressed that this was the reason he stopped having dinner since 2 months

. Diet: mixed, 2 idlies/ 2 purses for breakfast along with chutney,

2 cups of rice, along with tomato dal, and vegetable curry along with curd.

Dinner 2 chapatis and tomato dal.

GENERAL EXAMINATION

Patient was conscious , coherent , cooperative 

Moderately built , moderately nourished 

No signs of  pallor 

Icterus - absent 

Cyanosis - absent 

Clubbing - Present

Lymphadenopathy - absent 

Edema - absent 

 

Vitals

Pulse - 92 bpm

Bp - 110/ 80 mmhg 

Temp - afebrile (97.6 F)

Rr - 22 cpm 

SPo2: 100%

SYSTEMIC EXAMINTATION:

CVS: S1; S2 +,No murmurs heard

RS: BAE +

Crepitations heard in infra axillary, axillary, subscapular regions.

Ronchi are heard in infraclavicular area and axillary area.

CNS: No focal neurological defect

Per Abdomen :

INSPECTION: Shape of abdomen: scaphoid

Umbilicus  : inverted

Guarding of abdomen present.

No visible swellings, scars, sinuses ,engorged veins.

Patch present over the right lumbar region 

No visible peristalsis or pulsations

PALPATION:  

No local rise of temperature

Tenderness present in epigastric region

Liver is palpable, lower border is felt. 

On percussion, Liver Span: 13cm

Spleen not palpable, no spleenomegaly.

Percussion: bowel resonance felt. 

On auscultation, normal bowel sounds are heard.

INVESTIGATIONS 

HEMOGRAM

BLOOD LACTATE LEVELS

CUE

PROTHROMBIN TIME

BLOOD GROUPING AND TYPING 

APTT TEST

ECG

USG Report

PROVISIONAL DIAGNOSIS

Liver abscess 

Percutaneous drainage under local anesthesia done.

TREATMENT

10% NS@ 50ml/hr

Inj Sulbactum+ceforperazone(Magnex Forte) 1.5mg/IV/BD.

Inj metrogyl 500mg iv/TID

Pan 40mg BD

Inj paracetamol 1g/iv/TID

 Tablets: MultiVitamin OD

Vitamin C/OD

Vitamin K 10mg/IM STAT.