32 year old male with fever under evaluation

 32 year old male with fever under evaluation



32 year old male patient came to casualty with chief complaints of:
Fever since 3 months
Cough since 3 months
Vomitings since yesterday 
History of present illness :
Patient was apparently asymptomatic 3 months back,then he developed fever which was of high grade associated with headache, chills,continuous,more during night time.
C/O cough since 3 months,dry,no hemoptysis. 
Associated with shortness of breath. 
C/O vomitings since previous day, multiple episodes. Non blood stained, non bilious.
H/O weight loss present. 
H/O loss of appetite present. 
H/O paraplegia 3 months back,admitted, recovered with in 2 months.No bladder and bowel involvement. 
Past history:
H/O koch's 5 years back,used ATT for 4 months and stopped.
H/o paraplegia 3 months back, admitted and recovered a within 2 months, no bowel or bladder involvement. (?GBS)
H/O multiple suicide attempts present. 
Not a k/c/o DM,HTN,asthma,epilepsy,CAD.
Personal history :
Diet-mixed
Appetite-normal 
Sleep-adequate 
Bowel and bladder movements-regular
Alcoholic, stopped 1 and half year back
Smoking 1 pack/ day
General examination:
Vitals on admission:
Temperature-98.8 F
BP-100/80mmhg
PR-88 bpm
RR-17 cpm
Systemic examination:
CNS oriented to t/p/p 
                    Right     left
Power         
Upper limb   4/5     4/5
Lower limb  4/5      4/5
Reflexes 
Biceps          +2       +2
Triceps              -    -
Supinator          -    -
Knee                  -     -
Ankle                 -      -
Plantar flexor    extensor
Thoracic spine tenderness (+)


Referral of Department of Pulmonology i/v/o Cough since 3 months with h/o Pulmonary koch's used ATT for 4 months and stopped. Current cxr shows B/L cavities with sputum for AFB positive. 
Advised- To start ATT acc to FDC guidelines, T. Mucinac 600mg 1 tab in 1 glass water po/Tid, high protein diet, 2 egg a day.

 Dx- fever under evaluation with ?Pulmonary koch's (past h/o ?GBS (AMSAN TYPE)), past h/o peripheral neuropathy with past h/o pulmonary TB (?defaulter)

Treatment:
1)Tab.PCM 650 mg PO/TID
2)Temperature charting 4th hrly
3)Inj.Optineuron 1 amp in 100 ml NS/IV/OD


rx: 
Inj. Optineuron 1amp in 100ml NS IV/od
Inj. Neomol 100ml iv/tid
T. Dolo 650mg po/tid
T. Mucinac 600mg 1tab in q glass water po/tid x3days
Syp. Ambroxyl 15ml po/tid
High protein diet
2 egg whites a day
Temp charting 4th hrly
Bp/PR charting 

DX- Pulmonary koch's rifampicin sensitive

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