19/F CERVICAL LYMPHADENOPATHY


A 19 YEAR OLD FEMALE STUDENT PRESENTED TO THE PULMONOLOGY OPD WITH COMPLAINTS OF

FEVER SINCE 15 DAYS

COUGH SINCE 15 DAYS


HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC 15 DAYS BACK THEN SHE DEVELOPED FEVER, INTERMITTENT, HIGH GRADE, ASSOCIATED WITH EVENING RISE OF TEMPERATURE AND CHILLS, RIGOR, AND RELIEVED ON MEDICATION. PATIENT ALSO COMPLAINS OF COUGH SINCE 15 DAYS, BLOOD TINGED, NON FOUL SMELLING, NO AGGRAVATING OR RELIEVING FACTORS, NO SEASONAL VARIATION, NO DIURNAL/POSITIONAL VARIATION ASSOCIATED WITH CHEST PAIN ON COUGHING. NO COMPLAINTS OF CHEST TIGHTNESS, SOB, PALPITATIONS, DECREASED URINE OUTPUT, LOSS OF WEIGHT, LOSS OF APPETITE.


HISTORY OF PAST ILLNESS:

NO HISTORY OF SIMILAR COMPLAINTS IN THE PAST

NO HISTORY OF TB IN THE PAST

NO HISTORY OF INHALER USAGE IN THE PAST

NOT A KNOWN CASE OF DM, CAD, EPILEPSY, THYROID PROBLEMS

NO HISTORY OF SURGERIES OR BLOOD TRANSFUSIONS.

FAMILY HISTORY:

NO SIGNIFICANT FAMILY HISTORY

PERSONAL HISTORY:

DIET- MIXED

APPETITE- NORMAL

BOWEL AND BLADDER MOVEMENTS- REGULAR

SLEEP- ADEQUATE

ADDICTIONS- NONE

GENERAL EXAMINATION:

PATIENT IS CONSCIOUS, COHERENT, COOPERATIVE

VITALS-

TEMP-100.5F

PR- 110 BPM

RR- 20 CPM

BP- 110/70 MMHG

SPO2- 98% AT ROOM AIR

GRBS- 89 MG/DL

RESPIRATORY SYSTEM:

AUSCULTATION- 

BAE +VE, VBS HEARD

CREPTS RIGHT ICA MA


INVESTIGATIONS:

2D ECHO COLOUR DOPPLER DONE ON 28/2/23: TRIVIAL, GOOD LV SYSTOLIC FUNCTION, NO DIASTOLIC DYSFUNCTION

BLOOD CULTURE-1/3/23- NO GROWTH AFTER 24HRS OF AEROBIC INOCULATION

SPUTUM CULTURE- 3/3/23- <10 EPITHELIAL CELLS/LPF, >25 PUS CELLS/LPF, FEW GRAM NEGATIVE BACILLI SEEN, FEW GRAM + BACILLI SEEN, GRAM + COCCI IN PAIRS, NORMAL OROPHARYNGEAL FLORA GROWTH

SPUTUM CBNAAT 3/3/2023 NEGATIVE 

FNAC LYMPH NODE CBNAAT 3/3/2023. RIFAMPICIN SENSITIVE TB DETECTED.

URINE C/S DONE ON 1/3/2023.  NO GROWTH 

RETIC COUNT: 1

PERIPHERAL SMEAR: ANISOPOIKILOCYTOSIS PREDOMINANTLY WITH MICROCYTOSIS AND MACROCYTOSIS PENCIL FORN, TEARDROPS CELLS.

WBC: WITHIN NORMAL LIMITS WITH NEUTROPHILIA  

PLATELETS: INCREASED COUNT ON SMEAR

SERUM IRON: 56 MCG/DL

USG (28/2/23): E/O ENLARGED LYMPH NODES NOTED BILATERALLY AT LEVEL OF II, III, IV, V ON RT SIDE AND Ib, II, III, IV ON LT SIDE, LARGEST MEASURING 7-8MM AT LEVEL IV ON RT SIDE AND 6MM AT LEVEL III ON LT SIDE WITH INTACT FATTY HILUM. IMPRESSION: BILATERAL CERVICAL LYMPHADENOPATHY

FNAC C/S DONE ON 4/3/23


PROVISIONAL DIAGNOSIS:

RIGHT UPPER LOBE CONSOLIDATION WITH B/L CERVICAL LYMPHADENOPATHY 

SECONDARY TO TUBERCULOSIS WITH NUTRITIONAL ANEMIA ON ATT(IP)


TREATMENT GIVEN:

STARTED ATT (3 TABS/DAY) BBF UNDER NTEP PN 3/3/23

INJ, CEFTRIAXONE 1GM IV BD FOR 5 DAYS

INJ. PAN 40MG IV BBF OD

INJ. TRANEXA 500MG IV SOS

TAB. ETHAMSYLATE 250MG ORALLY BD

TAB. PCM 650MG ORALLY BD

SYP. GRILLINCTUS ORALLY TID 2 TSP

TAB. MVT ORALLY OD

TAB. OROFER XT ORALLY OD

TAB. LIVOGEN 150MG ORALLY OD

INJ. VITCOFOL 1 AMP IM OD 

TAB. BENADON 40MG ORALLY OD

HIGH PROTEIN DIET: 2 EGG WHITES/DAY

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