Concluded Case

15 year old,non smoker,2 wks h/0 cough,3 days h/0 fever with thrombocytopenia,altered RFT and LFT, breathlessness + ,streaky hemoptysis +

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Concluded answer

D/ds-pulmonary koch's (Miliary Tb),acute viral pnumonia,leptospirosis,dengue shock syndrome,ARDS,

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Bilateral parenchymal infiltrating shadows with milliary infiltration seen. Dds milliary TB or viral pneumonia Hepatorenal syndrome causing Pulmonary edema e.g.dengue shock syndrome..

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Bilateral widespread infiltrates , thrombocytopenia . Almost impending ARDS with multiorgan involvement . Think of H1N1 pneumonia . Patient is going to crash very soon . Do ABG , PT, PTTK, INR . Send throat swab for H1N1. Start bipap ,sos need to intubate & ventilation . Give fluids judiciously, avoid overhydration . Broad-spectrum iv antibiotics, oseltamivir , Azithromycin IV . Prognosis is guarded .

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Other than TB. Should also be kept in mind. Multiple system involved ie LFT, and RFT and thrombocytopemia. HIV should be ruled out Culture for Fungal infection.

D/ds-pulmonary koch's (Miliary Tb),acute viral pnumonia,leptospirosis,dengue shock syndrome,ARDS,

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Bilateral multiple infiltration miliary tuberculosis.

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Thank you all for your valuable opinion.Sputum AFB done was negative.We planned to start on ATT as a clinically diagnosed case.But that was with held in view of deranged RFT and LFT.. Meanwhile samples were sent for IgM lepto dengue scrub typhus,throat swab for H1N1.Pt was treated with cefosulbactam,doxy and oseltamivir.. patient improved symptomatically.Mean while lepto PCR came as positive.His repeat chest x-ray is attached here

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Aspergillosis.

Miliary Koch's

Miliary mottling. Investigate for tuberculosis Treatment after confirmation.

BILATERAL NODULAR OPACITIES BOTH SIDES MORE ON RT METASTATIC LESIONS

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