A 31 year old female with pyrexia under evaluation

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N Akshaya

Roll no 197

A 31 year old female came to opd with chief complaints of fever since 2 months and also headache since 2 months

History of presenting illness:

Patient was apparently asymptomatic 2 months back then she developed fever which is insidious in onset , associated with chills and headache .

No history of nausea and vomiting , no photophobia.

Phonophobia present,burning micturition present , complaints of generalised bodypains which is relieved on medication . Joints pains near knee and elbow present , no tenderness, no cough , cold , history of weight loss and loss of appetite .

SEQUENCE OF EVENTS : 

In 2019 -(i.e .., 3yrs ago )  She developed fever ,which was sudden in onset ,low grade , intermittent type ,  lasted for 2 months duration , which was diagnosed as typhoid fever, relieved on taking medication . 

but fever reccurs every 8 months ,since then .

In 2020 ,( i.e 2yrs ago ), she developed headache ,which was sudden in onset , lasted for 1hr duration , in the parietal region radiating to neck ,increased in intensity on exposure to loud sounds (phonophobia) , went to the hospital at Miryalaguda ,took medication for 20days ,and headache got relieved for few months .

then ,associated with fever ,which reccurs every 8 months .

In October 2022,(i.e ..,2months )  She developed joint pains ,which involves large joints and Spine .( small joints not involved ) . Intensity increases during night time, and lasts till 1 hour after wake up in the morning ,and relieves on performing daily chores , associated with fever.

Past history :

Not a known case of diabetes ,history , tb , asthma 

PERSONAL HISTORY 

Married

Appetite : normal      

Sleep: adequate 

Bowel and bladder: regular

Micturition : present 

Addictions : none 

Family history : 

No significant history   

Treatment history 

 No significant history 

Menstrual history :

Age of menarche : 14 

Lmp: 3/12/2022

Obstetric history :

Age at marriage : 17 

Para : 2

No of children : 2

No of abortions : 2

Birth history :

Cesserian section 

General examination :

Patient was conscious,coherent,cooperative,and well oriented to the time , place and person .

No pallor, icterus , cyanosis, clubbing , lymphadenopathy.

Vitals 

Bp : 130/90 mmhg

RR: 20 / min 

Pulse rate : 78 bpm

Temperature : afebrile

Gait : normal 

Systemic examination :

CVS : s1,s2 normal 

No Cardiac murmurs

Per abdomen :

No organomegaly

Cns examination..... 

no focal neurological deficits 

Cranial nerves are intact 

Investigations :

5/01/2023

Hb-12.2gm

TLC - 7,300

N/L/E/M: 50/39/3/8

PCV: 37.2

MCV : 81.6

MCH: 26.8

RBC: 4.56

PLT: 2.87

CUE: 

sugar : nil 

Albumin : nil

Bile salts : nil 

Bile pigments : nil 

Pus cells : 3-4 

RBS : 109 

LFT :

TB: 0.58

DV : 0.17

SGOT :23

SGPT : 37 

ALP : 90 

TP : 6.5 

A/G : 1.73 

RFT :

Urea - 14 

Creatinine - 0.6 

Uric acid - 2.4

Ca- 9.6

Ph- 3.0

Na+ 139

K -3.9

Cl - 105

Serology - negative hbsag, hcv, hiv

Provisional diagnosis:

Pyrexia under evaluation

Treatment : 

• IVF - normal saline and ringers lactate - 75ml / hour 

• tab dolo 650 mg /TID

•tan pantop 40 mg/ OD

•injection neomol 100 ml 

•tab ultracet 1/2 tab / OD