25year old male with fever and thrombocytopenia

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Case :

25 year old male, resident of nalgonda, came to the OPD with complaints of fever since 2 weeks.

Patient was apparently asymptomatic 2 weeks  back then he developed fever, which is on and off, high grade fever, associated with chills and rigors, which subsided on taking medication. After 2 days again he developed fever, for which he went to local hospital there he was diagnosed with typhoid for which he used medication. After 3 days, he had fever, which is low grade fever not associated with chills and rigors, for which he went to local hospital, there he was diagnosed wtih dengue positive.

H/o vomiting, 1 episode, non bilious, non projectile, food as content 

No h/o bleeding gums, melena, hemoptysis, hematemesis.

On examination

Patient C/C/C

No Pallor, icterus, cynaosis, clubbing, lymphadenopathy, edema 

VITALS 

Temp - Afebrile

BP - 100/60 mmHg

PR - 75 bpm

RR - 16cpm 

SpO2 - 98% at RA 

CVS - S1 S2 heard 

CNS - NFND 

RS - BAE+, NVBS heard 

P/A - Soft, non tender, bowel sounds heard 

Provisional diagnosis:

Fever with thrombocytopenia ( NS 1 positive)

Investigation:

Hemogram:

Hb - 15.6

TLC - 7,500

PCV - 44.5

Platelets - 1.17lakhs

CUE :

Albumin -

Sugar - 

Pus - 

RBC -

LFT : 

TB - 1.25

DB - 0.48

AST - 123

ALT - 86

ALP - 256

TP - 6.7

Blood grouping and typing : 

RFT :

Blood urea - 18

Sr.creatinine - 0.7

Sr. Na - 138

Sr. K - 4.5

Sr. Cl - 99

Serology ( HIV, HbsAg, HCV ) - Negative

Rapid dengue :

NS 1 antigen - postive 

IgM - negative 

IgG - negative 

ECG :

USG abdomen :

Chest X ray PA view :

Fever charting :

Treatment :

Day 0

- IVF - 1NS, 1RL, 1DNS @ 100ml/hr
- Inj. PAN 40mg IV OD
- Inj. ZOFER 4mg IV SOS
- TAB. PCM 650mg PO SOS

Day 1 

S:

Fever subsided 

O :
Pt C/C/C
Temp - 97.5 F
BP - 120/80 mmHg
PR - 80 bpm
RR - 17 cpm
SpO2 - 97% at RA
CVS - S1 S2 heard
RS - BAE present, NVBS heard
P/A - soft, non tender, BS +
CNS - NFND

A :
Dengue fever ( NS 1 POSTIVE ) with platelet count 1.17 lakh 

P :
- IVF - 1NS, 1RL, 1DNS @ 100ml/hr
- Inj. PAN 40mg IV OD
- Inj. ZOFER 4mg IV SOS
- TAB. PCM 650mg PO SOS

Day 2 

S:
Fever subsided 

O :
Pt C/C/C
Temp - 97.5 F
BP - 110/70 mmHg
PR - 70 bpm
RR - 17 cpm
SpO2 - 97% at RA
CVS - S1 S2 heard
RS - BAE present, NVBS heard
P/A - soft, non tender, BS +
CNS - NFND

A :
Dengue fever ( NS 1 POSTIVE ) with platelet count 1.5 lakh

P :
- IVF - 1NS, 1RL, 1DNS @ 100ml/hr
- Inj. PAN 40mg IV OD
- Inj. ZOFER 4mg IV SOS
- TAB. PCM 650mg PO SOS

Day 3

S:

Fever subsided 

O :
Pt C/C/C
Temp - 97.5 F
BP - 110/70 mmHg
PR - 78 bpm
RR - 16 cpm
SpO2 - 97% at RA
CVS - S1 S2 heard
RS - BAE present, NVBS heard
P/A - soft, non tender, BS +
CNS - NFND

A :
Dengue fever ( NS 1 POSTIVE ) with platelet count 1.86 lakh 

P :
- IVF - 1NS, 1RL, 1DNS @ 100ml/hr
- Inj. PAN 40mg IV OD
- Inj. ZOFER 4mg IV SOS
- TAB. PCM 650mg PO SOS

Day 4
S:
No Fever
No new complaints

O :
Pt C/C/C
Temp - 97.5 F
BP - 110/80 mmHg
PR - 80 bpm
RR - 17 cpm
SpO2 - 97% at RA
CVS - S1 S2 heard
RS - BAE present, NVBS heard
P/A - soft, non tender, BS +
CNS - NFND

A :
Dengue fever ( NS 1 POSTIVE ) with platelet count 1.94 lakh

P :
- IVF - 1NS, 1RL, 1DNS @ 100ml/hr
- Inj. PAN 40mg IV OD
- Inj. ZOFER 4mg IV SOS
- TAB. PCM 650mg PO SOS