Concluded Case

?false negative susp. covid,+ perforated gall bladder, UTI

10/09/20-male pt age 26,presented from bengal to mp via flight on 8th sept 2020,to opd with c/o fever. same day rtpcr RAT found -ve.next day invest revealed esr-65, crp-199,s.bilirubin-indir-1.55,neutrophilia, leucocytosis, increaaed basophil and monocytes, incr PDW, URINE hazy, redish yellow, wbc-15-25, rbc-30-35, occ. epi. cells. xray attached. given tab azithro 1 od and tab doxy 100mg bd. +symptomatic. 12th-then c/o hep tenderness febrile tachycard.. gastro openion found, platlet -427/cumm,esr-48,covid -ve, urine rm normalperforated gall bladder. operated for cholycystectomy. (laproscipic)on 16th.(t/t- feropenem, pcm, rifaximine all in rablet forms),. 24th sept- found again febrile , dry cough , rr-22/mt, referred to tertiary center for pulmonologist opinion, hrct had post of rt ul ggo, and B/l ll atelectatic bands.(sugg of inflammat etio) ( xray also attached.) t/t -ctall +stafcure lz, levoflox, calpol, all tabs were given. had mild relief. 26th - again fever 99f, and rr-26/mt.with basal crepts. RAT and rtpcr -ve. 28th- breathlessness, fever on and off, rr-36/mt, spo2-96%, rest vitals, left ll fine basal crepts. decreased apertite with no icterus. post op surgical wounds clear. dear doctors. it's my humble request to advice all the essential next line of investigations and your probable diagnosis for this patient. thank you in advance. Dr saurabh rathore

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Concluded answer

A case of perforation of Gall bladder with peritonitis . Patient has been operated for Gall bladder perforation. Post operative sequelae to surgery for G.B perforation are many- one of them can be Pulmonary Complications.. However-,we have seen that in many patients- patient may be having COVID-19 disease - but RT - PCR is negative as accuracy of RT - PCR is not 100 % . Many of these patients- we are diagnosing on HRCT CHEST- with CORADS grading and CT chest severity index . May be this patient have acquired COVID-19 disease in hospital- where he was operated. Further management- remains only symptomatic treatment

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A case of perforation of Gall bladder with peritonitis . Patient has been operated for Gall bladder perforation. Post operative sequelae to surgery for G.B perforation are many- one of them can be Pulmonary Complications.. However-,we have seen that in many patients- patient may be having COVID-19 disease - but RT - PCR is negative as accuracy of RT - PCR is not 100 % . Many of these patients- we are diagnosing on HRCT CHEST- with CORADS grading and CT chest severity index . May be this patient have acquired COVID-19 disease in hospital- where he was operated. Further management- remains only symptomatic treatment

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1

Do ddimer LDH il6 Score of hrct Walk test 5 minutes spo2 Both basal pneumonitis with ground glass favor sarscov2 Oxygen steriod if cytomic storm Cytolizubab lmwh bd methyl prednisolone earliest Antibiotics antiviral Xray not that bad Team work ecg 2 decho

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Perforated gall bladder with Peritonitis, with ? Early Post operative ARDS . GGOs are signs of lung inflammation and can be non specific. Proinflamnatory markers rise can be common to COVID INFECTION as well as bacterial infection and sepsis. This case can be NON COVID , bacterial infection . Negative RTPCR and RAT may not be necessarily wrong.

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Rule out heart failure basal crepts are suggestive. How much IV fluid is been given? Most of the ICU patient during hospital stay land to HF due to fluid overload. Do an ECHOCARDIOGRAPHY if the condition sustains.

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,CBC,SGPT,, regular oximetry, Higher antibiotics like inj meropenem1g 8hrly, Prednisolone 10 for 3weeks in tapering doses.Breathing exercises,by spirometer.

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Virologists are now saying that there are known variants that are not being recognized with PCR.

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Urine çulture/S LEPTO IGM@ BL CULTURE WIDAL DENGU IGM @

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I agree with Dr Parveen yograj

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Thank you doctor

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