A CASE OF PUO

45 y female H/o fever(> 102°c) for last 1 month . oxygen saturation falling below 80 in room air . hospitalised. Investigations: CBC : wNL . CRP : 33.5 mg /l . D dimer : 992 mg/ml ESR: 33 mm/hr NT BNP 303 LFT : GGT - 286 ALP 716 AST 94 ALT 88 OTHER WNL BLOOD c/s: negative Urine c/s: negative scrub typhus: negative Brucella : negative COVID19: negative Anti LKM ; Anti AMA ab : negative CT: ABDOMEN : Mild hepatomegaly CT : CHEST : Extensive ground glass opacity at base of B/L lung. Treatment : initially PREDNISOLONE was started . now maintained on DOXYCYCLINE ; PCM and Dytor. DIAGNOSIS ?

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Consider a case of PUO. See for HIV status. Echo CD to rule out cardiogenic Pulmonary edema and PAE. Connective tissue disorder profile. Acute liver cell injury. Cryptogenic organising pneumonia. Plz upload CT thorax images and clinical examination details.

HIV status : negative ECHO : wNL except for mild mitral regurgitation H/O Rheumatoid arthritis + now RF 8.6 iu/l ASO 25IU /ML anti CCP <7 I will try to upload CT images later. Thank you.
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Rule out history of birds exposure .... can be sub-acute Hypersensitivity pneumonitis

Also get full ANA 17 profile

Infiltrative liver disorder !

Bird flu swine flu