A young female aged 18 yrs presented with history of Fever with chills , breathlessness since 5-6 days and altered sensorium since 1 day.....On taking history from attendants, it was revealed that She has had 2-3 episodes of Jaundice in last 2 yrs and 3 PRBC transfusions were also done 8 months back due to severe anemia....She was foundto have clubbing...Discuss this interesting case and possible differentials...


It may b malaria parasite. Severe a plastic anaemia.sickle cell anaemia or auto immune hemolytic anaemia so adv pt aptt kft.lft and iron profile and csf and ct scan and transfuse whole blood
Peripheral smear findings.. general blood picture.. should also be done..
Based on history there appears to be a hemolytic anaemia with an acute episode of fever..fever may be due to pneumonia(xray showing rt lower zone consolidation with cardiomegaly), infective endocarditis(clubbing and cardiomegaly with mostl probably rt atrial enlargement) Differentials are malarial fever with rt pneumonia with febrile delirium, infective endocarditis with pneumonia, meningitis due to septic emboli in infective endocarditis, hepatic encephalopathy due to acute episode of hemolysis in haemoglobinopathy with congenital heart disease..kindly also.elicit drug history for probable contribution to hemolysis in this acute episode.cbc with esr, lft, rft, se ldh and haptoglobin, peripheral smear for malarial parasite and cell morphology, dct and ict, hb electrophoresis, lt lateral chest xray, 2 d echo, csf, blood cultures(3), ct brain..antibiotic(3 rd generation cephalosporin-empirically), hydration, bowel evacuation(lactulose via rt or enema),.
The patient is now having right lower love consolidation s/o pneumonia with septicemia, it may be due to decreases immunity as splenomegaly might be clearing all the b and t cells.routine blood with peripheral smear and reticulocyte count will help I think.is she having jaundice now?also some occult congenital heart disease might be there.
Spleen size? Urine colour? H/o blood in stool, urine? Agree with Dr Sumit Gupta listed DDs. Peripheral blood picture, reticulocyte count, IEP, CUE, USG abdomen along with other mentioned. ICU admission and hydration is priority along with simultaneous evaluation. Involve hematologist.
Agree with @Dr Annu
DD are hemoglobinopaties, thalassemia,sickle cell disease in sicklecell anemia due to auto splenectomy pts are, susceptible to pneumococcal and salmonella infections.in hepatitis viral infection patients are prone to aplastic anemia.
Clubbing is the feature of obstructive jaundice and altered sensorium is there so this can be due to hepatic encephalopathy but interstitial lung diseases to be ruled out for cause of breathlessness
Since there is h/o 2 to3 episodes of jaundice she may have land as a c/o hepatic failur with encephalopathy. This can be associated rt lower lobe congestion with mild ascitis
Thanx dr Dr Malikender patel patel
r/o Bacterial endocarditis or chronic hepatitis Adv- hepatitis serology, LFT, 2D ECHO, blood cultures.
What are the investigations done.what about LFT,KFT,SERUM ELECTROLYTES,CBP WITH PLATLETS.
It looks like hepatic encephalopathy
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