A 26 year old male with fever, headche, vomitings and loose stools

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 26 year old male came with c/o Fever since 1 week

c/o generalised weakness and headache since 1 week

c/o vomitings since 3 days

c/o loose stools since 3 days

History of presenting illness:

Patient was apparently alright 1week ago then he developed fever which is high grade, intermittent, associated with chills and rigor.

He was in Orissa while he developed fever then he returned to his home 2 days later.

He also had headache and generalised weakness since 1 week

He developed vomitings since 3 days, 5 episodes, with food as content, non bilious, non projectile, not blood stained

Loose stools since 3 days, 3 episodes/day, watery, green coloured, not blood stained.

He went to a doctor outside but the symptoms didnot subside, then he came here on 7/6/23

H/o hematuria and green coloured stools since 3 days

There is H/o taking papaya leaf juice for 3days in the morning before food 

Past history 

No H/o similar complaints in the past

Not a k/c/o DM, HTN, Thyroid disorders, epilepsy, asthma.

Personal history 

He has normal appetite, takes mixed diet, increased bowel movements, sleep is adequate.

He takes alcohol 2 quarters from 6 years 

On examination:

Patient is conscious, coherent and cooperative 

No pallor, clubbing, cyanosis, lymphadenopathy, pedal edema 

Vitals

Temp- 99.5F

PR- 86 bpm

RR- 20 cpm

BP- 100/70mmHg

Spo2 - 99% on RA

RS-B/L air entry present 

       NVBS

CVS- S1S2 present, no murmurs heard

PA- Soft,non tender

CNS: NAD

Investigations 

On 7/6/23

Hb: 14.9gm/dl

TLC: 900cells/cumm

RBC: 4.79 millions/cumm

PLATELETS: 50000 /cumm

Blood urea:52 mg/dl

Serum creatinine: 1.4 mg/dl

Serum Na+:137 mEq/L

Serum K+:4.3mEq/L

Serum Chloride:99 mEq/L

Bleeding time: 2min 30sec

Clotting time: 5min 00sec

PT: 20sec

INR: 1.4

APTT:41 sec

Stool for occult blood: Positive 

CUE

Albumin:+

Pus cells: 3-4/HPF

RBC: plenty

On 8/6/23

Hb: 13.3gm/dl

TLC: 900cells/cumm

Platelets: 50000 /cumm

RBC: 4.17million/cumm

Peripheral smear

RBC: Normocytic normochromic

WBC: counts decreased on smear

Platelet: counts decreased on smear

On 9/6/23

Hb: 12 gm/dl

TLC: 1300cells/cumm

RBC:3.78million/cumm

Platelets: 90,000/cumm

PCV: 35.4vol%

Serum creatinine:0.9mg/dl

Serum Na+ :139mEq/L

Serum K+: 4 mEq/L

Serum Chloride: 101mEq/L

APTT:43 Sec

PT: 22Sec

INR:1.62

Total Bilirubin: 4.93 mg/dl

Direct bilirubin: 3.46mg/dl

SGOT: 50 IU/L

SGPT: 18IU/L

Total proteins 5.0gm/dl

Albumin: 2.44gm/dl

A/G ratio: 0.95

On 10/6/23

Total Bilirubin: 2.37 mg/dl

Direct bilirubin: 1.99 mg/dl

SGOT: 79 IU/L

SGPT: 25 IU/L

Total proteins 4.5 gm/dl

Albumin: 1.69 gm/dl

A/G ratio: 0.58

Hb: 11.5 gm/dl

TLC: 1100 cells/cumm

RBC:3.63 million/cumm

Platelets: 62,000/cumm

PCV: 34.2 vol%

On 11/6/23

Total Bilirubin: 1.57 mg/dl

Direct bilirubin: 0.65 mg/dl

SGOT: 64 IU/L

SGPT: 30 IU/L

Total proteins 4.6 gm/dl

Albumin: 2.21 gm/dl

A/G ratio: 0.92

Hb: 11.3 gm/dl

TLC: 2000 cells/cumm

RBC: 3.58 million/cumm

Platelets: 70,000/cumm

PCV: 34 vol%

On 12/6/23

Hb: 11.6 gm/dl

TLC: 2400 cells/cumm

RBC: 3.66 million/cumm

Platelets: 80000/cumm

PCV: 35.2 vol%

Total Bilirubin: 1.17 mg/dl

Direct bilirubin: 0.23 mg/dl

SGOT: 62 IU/L

SGPT: 49 IU/L

Total proteins 6.2 gm/dl

Albumin: 3.3 gm/dl

A/G ratio: 1.74

Serum electrolytes 

Serum Na+ :140mEq/L

Serum K+: 4mEq/L

Serum Chloride: 100mEq/L

Diagnosis:

Pyrexia with bicytopenia

Treatment:

1.IV FLUIDS NS, DNS, RL@ 125 ml/hr  

2.Tab.DOLO 650mg PO/TID

3.Inj.NEOMOL 1gm IV/SOS (if temp>102F)

4.Monitor vitals