50 F CKD TB LYMPHADENITIS

 A 50YEAR OLD FEMALE PATIENT RESIDENT OF NALGONDA PRESENTED TO OPD WITH COMPLAINTS OF

C/O FEVER SINCE1 MONTH
GENERALISED BODY PAINS SINCE 10 DAYS
B/L LOWER LIMB EDEMA SINCE 3 DAYS
VOMITINGS SINCE 3 DAYS
SHORTNESS OF BREATH SINCE 2 DAYS
ABDOMINA PAIN SINCE 1 DAY
HISTORY OF PRESENTING ILLNESS: 
PATIENT WAS APPARANTLY ASYMPTOMATIC 1 MONTH AGO, THEN DEVELOPED FEVER, HIGH GRADE ASSOCIATED WITH CHILLS, INTERMITTENT TYPE, RELIEVED WITH MEDICATION, NO DIURNAL VARIATION, GENERALISED BODYPAINS SINCE 10 DAYS SHORTNESS OF BREATH SINCE 2 DAYS, INSIDIUOS IN ONSET AND GRADUALLY PROGRESSIVE FROM GRADE 2 TO GRADE 3
NO ORTHOPNEA, NO PND
VOMITINGS SINCE 3 DAYS, CONTENT FOOD MATERIAL, NON BILIOUS, NON PROJECTILE ABDOMINAL PAIN, DIFFUSE, NON RADIATING
B/L LOWER LIMB PEDAL EDEMA, PITTING TYPE EXTENDING UPTO KNEE.
DIDNOT PASS STOOLS SINCE 5 DAYS.
NO H/O LOOSE STOOLS, CHESTPAIN.
HISTORY OF PAST ILLNESS:
K/C/O HTN, SINCE 2
?AKI ON CKD S/P 4 SESSIONS HD DONE 1 YEAR AGO [STOPPED MEDICATION 10 DAYS AGO]
N/K/C/O DM 2, CAD, CVD, EPILEPSY, ASTHMA,THYROID DISORDERS.
FAMILY HISTORY:
NO SIGNIFICANT FAMILY HISTORY.
PERSONAL HISTORY:
DIET :MIXED
APPETITE: GOOD
SLEEP: ADEQUATE
BOWEL: DIDNOT PASS STOOL SINCE 5 DAYS BLADDER HABITS: REGULAR
GENERAL EXAMINATION:
patient is conscious,coherent and cooperative. 
well oriented to time,place and person.
thin built and Moderately nourished. 
Pallor-present.
Icterus-no.
No cyanosis, clubbing, lymphadenopathy.
pedal edema-present.
VITALS:
BP-160/90 mmhg.
TEMP- afebrile.
RR-28cpm.
PR-100bpm.
spO2- 98%@ra.
GRBS-124mg/dl.
SYSTEMIC EXAMINATION:
CVS- S1S2 heard, no murmurs. 
CNS- No focal deficits. 
RS: BAE + , NVBSHEARD
PA: DIFFUSE ABDOMINAL TENDERNESS +
HEPATOMEGALY +, BS +


 ABG 25-10-2023 12:27:AM PH7.12PC0214.0P0277.6HC034,4St.HCO37.2BEB-23.6BEecf-23.5TCO210.002 Sat94.302 Count10.1HBsAg-RAPID25-10-2023 01:37:AMNegative Anti HCV

Antibodies - RAPID25-10-2023 01:38:AMNon Reactive BLOOD UREA25-10-2023 01:38:AM272

mg/dISERUM CREATININE25-10-2023 01:38:AM12.3 mg/dISERUM ELECTROLYTES (Na, K, C 1) AND SERUM IONIZED CALCIUM 25-10-2023 01:38:AM SODIUM128 mEq/LPOTASSIUM5.5 mEg/LCHLORIDE106 mEq/LCALCIUM IONIZED1.10 mmol/LPHOSPHOROUS25-10-2023

01:38:AM6.6 mg/dILIVER FUNCTION TEST (LFT) 25-10-2023 01:38:AM Total Bilurubin0.99

mg/diDirect Biturubin0.16 mg/dISGOT(AST)13 IU/LSGPT(ALT)12 IU/LALKALINE PHOSPHATE337

IU/LTOTAL PROTEINS5.3 gm/dIALBUMIN2.9 gm/dIA/G RATIO1.17STOOL FOR OCCULT BLOOD25-10-2023 12:24:PMPOSITIVE (+VE)COMPLETE URINE EXAMINATION (CUE) 25-10-2023 01:41:PM COLOURPale

yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMINNiISUGARNiIBILE

SALTSNiIBILE PIGMENTSNiIPUS CELLS2-3EPITHELIAL CELLS2-3RED BLOOD

CELLSNiICRYSTALSNiICASTSNiIAMORPHOUS DEPOSITSAbsentOTHERSNiIBLOOD UREA25-

10-2023 10:54:PM210 mg/dISERUM CREATININE25-10-2023 10:54:PM8.4 mg/dISERUM

ELECTROLYTES (Na, K, C 1) AND SERUM IONIZED CALCIUM 25-10-2023 10:54:PM SODIUM130 mEg/LPOTASSIUM4.2 mEg/LCHLORIDE96 mEg/LCALCIUM IONIZED1.00 mmol/LPOST LUNCH BLOOD SUGAR25-10-2023 10:54:PM105 mg/dIT3, T4, TSH 25-10-2023 10:54:PM T30.14

ng/m/T42.82 micro g/dITSH3.86 micro lu/mICOMPLETE URINE EXAMINATION (CUE) 27-10-2023

12:40:AM COLOURPale

yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMIN+SUGARNIBILE

SALTSNIBILE PIGMENTSNIIPUS CELLS2-4EPITHELIAL CELLS2-3RED BLOOD CELLSNICRYSTALSNIICASTSNIIAMORPHOUS DEPOSITSAbsentOTHERSNIIBLOOD UREA27-

10-2023 12:40:AM246 mg/diSERUM CREATININE27-10-2023 12:40:AM9.9 mg/dISERUM

ELECTROLYTES (Na, K, C 1) AND SERUM IONIZED CALCIUM 27-10-2023 12:40:AM SODIUM132 mEg/LPOTASSIUM4,4 mEg/LCHLORIDE98 mEg/LCALCIUM IONIZED0.93 mmol/LABG 27-10-2023

05:52 AM PH7.24PC225.3P0270.0HC0310.7StHC0312.6BEB-15.1BEecf-15.2TC0223.802

Sal93.202 Count9 4BLOOD UREA28-10-2023 12:58:AM256 mg/dISERUM CREATININE28-10-2023 12:58:AM9.1 mg/dISERUM ELECTROLYTES

(Na, K, C 1) AND SERUM IONIZED CALCIUM 28-10-2023 12:58:AM SODIUM131 mEq/LPOTASSIUM5.3 mE/LCHLORIDE98 mE/LCALCIUM IONIZED0.90 mmo/LBLOOD

UREA29-10-2023 03:48:AM125 mg/dISERUM CREATININE29-10-2023 03:48:AM4.9 mg/dISERUM

ELECTROLYTES (Na, K, C I) AND SERUM IONIZED CALCIUM 29-10-2023 03:48:AM SODIUM134 mEq/POTASSIUM5.1 mEq/LCHLORIDE99 mEq/LCALCIUM IONIZED1.10 mmol/LBLOOD

UREA29-10-2023 11:40:PM145 mg/dISERUM CREATININE29-10-2023 11:40:PM5.7 mg/dISERUM

ELECTROLYTES (Na, K, C I) AND SERUM IONIZED CALCIUM 29-10-2023 11:40:PM SODIUM132 mEq/POTASSIUM4.4 mEq/LCHLORIDE94 mEq/LCALCIUM IONIZED1.00 mmol/LBLOOD

UREA31-10-2023 12:55:AM156 mg/dISERUM CREATININE31-10-2023 12:55:AM6.9 mg/dISERUM

ELECTROLYTES (Na, K, C I) AND SERUM IONIZED CALCIUM 31-10-2023 12:55:AM SODIUM128

mEq/LPOTASSIUM4.6 mEq/LCHLORIDE98 mEq/LCALCIUM IONIZED1.00

mmol/PHOSPHOROUS31-10-2023 12:55:AM6.0 mg/dIBLOOD UREA01-11-2023 12:39:AM159

mg/dISERUM CREATININE01-11-2023 12:39:AM7.2 mg/dISERUM ELECTROLYTES (Na, K, CI) AND SERUM IONIZED CALCIUM 01-11-2023 12:39:AM SODIUM130 mEq/LPOTASSIUM4.5 mEq/CHLORIDE95 mEq/LCALCIUM IONIZED1.11 mmol/LPHOSPHOROUS01-11-2023

12:39:AM6.2 mg/di

USG FINDINGS: E/O MULTIPLE ENLARGED LYMPHNODES NOTED IN EPIGASTRIC REGION AROUND AORTA LARGEST MEASURING 12 M

APPENDIX NOT VISUALISED

NO INFLAMMATORY CHNAGES IN RIF

IMPRESSION: B/L GRADE 3 RPD CHANGES; MESENTERIC ( PARAAORTIC) LYMPHADENOPATHY MODERATE ASCITIS

BLOOD C/S : NO GROWTH AFTER 24 HOURS OF AEROBIC INCUBATION

URINE C/S: ENTEROCOCCUS SPECIES 10 POWER 5 CFU/ML OF URINE ISOLATED FNAC FROM RIGHT CERVICAL LYMPHNODE : F/S/O GRANULOMATOUS LYMPHADENITIS

CORRELATES WITH CBNAAT REPORT

CASEOUS NECROSIS PRESENT

SPUTUM TRUNAAT POSITIVE

USG NECK: TIRADS 3 AND 4 LESION IN RIGHT LOBE OF THYROID CERVICAL LYMPHADENOPATHY.

COURSE IN HOSPITAL :50 YUEAR OLD FEMALE WITH ABOVE COMPLAINTS WAS EVALUATED CLINICALLY AND WITH APPROPRIATE INVESTIGATIONS TRUNAAT POSITIVE AND FNAC OF CERVICAL LYMPHNODE DONE SHOWING CASEOUS NECROSISAND WAS PROVISIONALLY



























DIAGNOSED AS CKD WITH EPTB - TB LYMPH ADENITIS

AND STARTED ON ATT WITH RENAL MODIFIED DOSE 4 TABS/DAY

The patient passed away at home in December 2023.


OUTCOME -  MORTALITY




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