A young male aged 18 yrs presented with complaints of pain abdomen and generalised weakness since a month....No h/o constipation, loose stools or bleeding was present...Stool FOBT was negative but he was having sevwre pallor....Comment on the approach to this patient....

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Its a case of pleural effusion.

Dengue

Looks like infective etiology.....x Ray shows pleural effusion tap an see...Specifically look for ADA levels and also to look for fluid cholesterol

Issues Pleural effusion + Ascites + lymoahdenopathy + Raised create Infective etiology involving multiple systems most likely eg disseminated kochs.. I would suggest Pleural and ascitic fluid diagnostic tapping , rule out exudative vs transudative fluid....do ADA, LEH ,protein and sugars... Also Do urine routine for proteinuria..other possibility of nephrotic syndrome...

If he has fever ...D/D may be leptospirosis
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Amoebic hepatitis wth pleural effusion.maybe burst abscess,or sympathetic effusion.

Amoebic abscess has been heard....wts amoebic hepatitis?
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PLEURAL EFFUSION

Pleural effusion Chronic kidney disease R/o disseminated koch

Enteric fever

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