6 yrs/M presented with 6 hrs h/o giddiness , vomiting and one e/o tonic posturing f/b loss of consciousness. CNS exam GCS E2V3M4 , pupil NSNR, FLEXOR POSTURING on stimulus , DTR brisk , planter UP GOING , tone RAISED. Multiple boil/rash all over the body for 5 days .NO HISTORY OF FEVER a/c to mother. HR 72 , RR 24 BP 109/44. Eptoin , mannitol , emeset given and patient is intubated in view of poor GCS , persistent POSTURING and vomiting and CO2 retention. Can u please tell the PROBABLE DIAGNOSIS (remember; patient is FEVER FREE )?????

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Looks like Eschar commonly seen in Rickettsial disease. To confirm send Weil Felix and emperically start Doxycycline.
ricketessial pox virus related meningitis
Ok sir , So I should give doxycycline ???
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Bacterial meningitis ?
S/s is acute( all happened within 4 hrs) indicating encephalitis> meningitis. NCCT is normal
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Meningoencephalitis.
NCCT is normal so should I plan for MRI and LP ???
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Meningoencephalitis Rx Inj Mannitol Emeset Metro Zostum And do fast MRI as soon as possible Ready to with venti
Sir , patient is on ventilator with normal setting
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Afebrile....may be metabolic encephalopathy Can u tell me ammonia and lactate level
See for the neck stiffness..... If present 100 percent payomeningitis
1st diagnosis is eptoin induce drug rash 2nd is bullous impetigo
But Sir , patient is having rash/boil for 5 days and eptoin was given yesterday night
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???? Staphyloccal menengitis.
Tetanus Meningoencephalitis
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