Case of 47yrs female patient with shortness of birth & urticaria

 Hi I am R.Gopal, a medical student in India. This blog is a collection of cases reviewed by me under the guidance of my seniors. This blog aims to elaborate on cases, their treatments and increase our understanding of patient care at the undergraduate level. Happy reading:)

47 YEAR OLD FEMALE WITH SOB, URTICARIA AND EXTRAMPULMONARY TB

PRESENTING COMPLAINTS:
 Generalized Itching since a month.
Shortness of breath since 10 days.
Abdominal pain since 7 days.
Lower back pain since 7 days.

HOPI:
She is a known case of Extrapulmonary tuberculosis with Ascites. She has been taking treatment since (ATT)21/07/2022. Now she came to the OPD with complaints of Itching all over her body since 7- 10 days after starting the ATT regimen. There is gradual increase in size of abdomen. She complains of back pain since 1 week. 

PAST ILLNESS:
6 years back Patient was giddy and went to a local hospital where she was diagnosed with diabetes mellitus. She took oral hypoglycemics and was later shifted to insulin after 4 years. 5 months ago she had complaints of pedal edema, she sought for consultation at a local hospital and got discharged after reduction in pedal edema. Now patient complains of shotness of breath even while dressing and sitting and gradual abdominal distension. Ascitic tap was done and reports were found to be Low SAAG Low protein. She was diagnosed with HTN and Hypothyroidism. 
Enlarged cervical lymph nodes were present and USG NECK was ordered it showed which showed B/L discrete lymphnodes at level I B/ II/ III/ IV. 


FNAC was done on 25/06/2022 which showed findings s/o - Chronic granulomatous lymphadenitis - possible TB.

Ascitic fluid culture and sensitivity showed growth of E. Coli.

 Exicisonal biospy was done and patient started on ATT. 


FAMILY HISTORY:
Mother was Diabetic.


SURGICAL HISTORY:
Tubectomy. 

PERSONAL HISTORY:
Normal Appetite
Decreased food intake because of SOB and abdominal distention.
Irregular Bowel - hard stools.
Decreased Micturition.
No addictions.

FAMILY HISTORY:
Mother was Diabetic.


GENERAL EXAMINATION:
Patient was conscious and coherent.
Pallor +
clubbing+
lymphadenopathy+
pedal edema +
cyanosis -
Icterus -

VITALS:
 PR: 101
BP: 150/90 mmHg

ECG

Chest Xray

Previous investigation

Present investigation

Treatment
1. TAB. LASIX 40MG/PO/BD.
2. TAB. TELMA 40 MG/PO/OD.
3. TAB. METOLAZONE 10MG/PO/BD.
4. TAB. OROFER XT /PO/OD.
5. TAB. THYRONORM 100mcg/PO/OD.
6. CAP. BIO D3/PO/ONCE WEEKLY.
7. INJ. HUMAN ACTRAPID INSULIN/ ACCORDING TO GRBS/TID.
8. TAB. RIFAMPICIN 450MG
9. TAB. ISONIAZID 225MG
10. TAB. PYRAZINAMIDE 1200MG
11. TAB. ETHAMBUTOL 825MG


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