A 25 yrs old female pt c/o fever on /off since 1 month Decreased urine out , Pedel Edema and puffy face swelling lips Ulcers in oral cavity O/I HB % 7.0 gms , WBC 2,200 .platelets 60,000 RFT s/creat 1.2 B/U 30 Electrolytes. Na+ 132 K+ 3.2 cl 99 N /K/0 Dm , HTN , thyroid Provisional Dx VIRAL PYREXIA WITH TCP ?Anasarca ,anemia ?HYPOTHYROIDISM ?Nephrotic syndrome Dx and treatment plz
Auto immune disease
History suggest pt is renal failure as clinical signs and pmx DM/HTN Probably pt has CKD Thrombocytopenia may be a/w viral fever which excerbated CKD There is hyponatremia Anaemia and early deranged kft
ANEMIA STOMATITIS HYPOPROTEINEMIA THROMBOCYTOPENIA LEUKOPENIA LEADING TO NEPHROPATHY/CKD THESE ALL SEEMS DUE TO SEVERE VIRAL INFECTION TO BE EVALUATED PROPERLY INCLUDING ALL REQUIRED HEMATOLOGICAL INVESTIGATIONS CT ABD-PELVIS USG VIRAL MARKERS INCLUDING DENGUE MALERIA....TO CONCLUDE
IT'S A..CASE OF.. ? ANEMIA..WITH.. GLOSSITIS-STOMATITIS..& .. HYPOPRITEINEMIA.. ? NEPHROTIC SYNDROME..? CKD .. NEED'S CLINICOPATHOLOGICAL EVALUATION WITH.. * ANEMIA PROFILE .. * URINE ROUTINE.. * LFT..KFT.. * BSR .. * TFT.. USG STUDY ABDOMEN..
Pancytopenia with fever Causes can be intrinsic causes 1) Intrinsic causes are bone marrow related, causing suppression of all cell line, because of leukemia, lymphoma, myelodysplastic syndromes It requires peripheral smear and bone marrow aspiration Extrinsic causes They can be Viral infections - HIV, Epstein Barr virus, Cytomegalovirus, parvovirus Bacterial infections - Typhoid and shigella Parasitic infection - Malaria and Kala Azar Zoonotic diseases - Brusellosis and Tularaemia Hemolytic disorders - Thrombotic thrombocytopenic purpura, Hemophago lympho histiocytic syndrome, liver disease
Hypothyroidism with PUO. Needs further investigation and evaluation to conclude and treatment plan. PCM SOS. Clavam cl 625 mg bd. Low salt diet. Multivitamin and antioxidants orally. Green leafy vegetable and plenty of nutritious balanced liquid diet. Till reports complied.
LOW GRADE FEVER = I MONTH OLIGURIA ANASARCA ORAL ULCER6 ANAEMIA ++ LEUCOPENIA THROMBOCYTOPENIA SLIGHTLY LOW K + REPORTS TO BE MADE AVAILABLE -------------------------------------- RBC = COUNT PERIPHRAL BLOOD PICTURE MCV SERUM IRON FERRITIN = HYPOPLASTIC ANAEMIA TO BE EXCLUDED SHE CAN HAVE FEVER EDEMA OLIGURIA ORAL ULCER = ALL -------------------------------------- SETUM PROTEIN ALB : GLOB URINE = PROTEIN CASTS RBC WBC TO EXCLUDE NEPHROTIC SYNDROME ----------------------------------------------------CLINICAL EXAM LIVER SPLEEN LYMPH NODES CHEST EXAM & CXR FOR LOW GRADE FEVER = TO EXCLUDE TB ---------------> MALNUTRITION EDEMA= DUE TO HYPOPROTEINAEMIA BONE MARROW DEPRESSION DUE TO MILIARY SPREAD ORAL ULCER DUE TO VITAMIN B DEFICIENCY
I guess the key investigation we are missing here is Serum Protein and Albumin and 24 hr urinary protein alongwith Urine routine The pt looks like a case of Nephritic/Nephrotic syndrome with Pancytopenia... Bone marrow evaluation alongwith a trial of steroids will be worthy
D/D Acute Glomerulonephritis Nephrotic Syndrome Hypoproteinemia With Anemia & global defecincy of vitamins & minerals
SUGGESTIVE. OF .. PYREXIA PANCYTOPENIA POSSIBLY... DRUG. INDUCED HYPOTHYROIDISM ANEMIA ACUTE. RENAL. FAILURE..
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