78F LEFT INGUINAL LYMPHADENITIS

 78/F House wife by occupation from miryalguda came to general surgery OPD WITH C/O SWELLING IN THE LEFT SIDE OF THE ABDOMINAL REGION SINCE

15 DAYS

HISTORY OF PRESENTING ILLNESS:

PATIENT WAS APPARENTLY ASYMPTOMATIC 15 DAYS AGO THEN SHE DEVELOPED SWELLING IN THE LEFT LOWER ABDOMINAL TO GROIN REGION WHICH WAS INSIDIOUS IN ONSET AND GRADUALLY INCREASED TO THE PRESENT SIZE SWELLING WAS ASSOCIATED WITH PAIN WHICH WAS AGGRAVATED UPON STRAINING .NO RELIEVING FACTORS

NO H/O FEVER, VOMITINGS, NAUSEA NO H/O BOWEL AND BLADDER DISTURBANCES 

PAST HISTORY:

PREVIOUS H/O LAPROTOMY SURGERY 2002 AT SURYAPET

N/K/C/O DM,HTN,CVA, CAD, ASTHMA, EPILEPSY, THYROID DISORDERS 

GENERAL EXAMINATION:

PATIENT IS CONSCIOUS ,COHERENT, COPERATIVE

TEMPERATURE-AFEBRILE 

PR 88 BPM

RR 18CPM

BP 110/80 MMHG

GRBS 110 MG/DL

SYSTEMATIC EXAMINATION

CVS S1 S2 HEAED NORMAL 

RS - BILATERAL AIRENTRY PRESENT NORMAL VESICULAR BREATH SOUNDS HEARD

CNS - NFND

LOCAL EXAMINATION: LEFT INGUINAL REGION

ON INSPECTION-

A SOLITORY OVAL SHAPED SWELLING OF SIZE 3 X 4 CMS NOTED OVER THE LEI

REGION

SURFACE OVER THE SWELLING IS SMOOTH

SKIN OVER THE SWELLING IS NORMAL

NO VISIBLE PULSATIONS

NO VISIBLE COUGH IMPULSE

ON PALPATION-

TENDERNESS PRESENT OVER THE SWELLING

NO LOCAL RISE OF TEMPERATURE

ALL INSPECTORY FINDINGS ARE CONFIRMED WITH RESPECT TO SIZE,SHAPE

SURFACE

HARD IN CONSISTENCY

SKIN PINCHABLE

SWELLING IS MOBILE

PULMONOLOGY REFFERAL DONE ON 29/2/24 I/V/O FNAC OF THE SWELLING SUGGESTIVE OF GRANULOMATOUS NECROTISING LYMPHADENITIS.

ADVISED;

SPUTUM FOR GRAM STAIN ,C/S,FUNGAL STAIN AND CULTURE, AFB, TRUNAT.

LYMPHNODE FNAC FOR TRUNAT/AFB SMEAR FOR CONFIRMATION OF TB .

SYP.ASCORIL-LS 2 TSP/PO/TID

INVESTIGATIONS 

SERUM SODIUM 139mEQ/L

SERUM POTASSIUM 3.5mEQ/L

SERUM CHLORIDE 99mEQ/L

COMPLETE BLOOD PICTURE (CBP) 26-02-2024 

HAEMOGLOBIN10.9 gm/di

TOTAL COUNT7600 cells/cumm

NEUTROPHILS 58 %

LYMPHOCYTES 32 %

EOSINOPHILS O2 %

MONOCYTES 08 %

BASOPHILSO %

PLATELET COUNT2.52

COMPLETE URINE EXAMINATION (CUE) 26-02-2024 

COLOUR Pale yellow

APPEARANCE Clear

REACTIIN - Acidic

ALBUMIN - NIL

SUGARS - nil

BILE SALTS

Nil

BILE PIGMENTS

Nil

PUS CELLS 2-3

EPITHELIAL CELLS 2-3

RED BLOOD CELLS Nil

CRYSTALS Nil

CASTS Nil

AMORPHOUS DEPOSITS Absent

OTHERS Nil

BLOOD UREA - 25mg/dl

SERUM CREATININE- 0.8 mg/dl

HIV,HCV,HBSAG NON REACTIVE

USG OF SWELLING :

E/O 34 X 10 MMILL DEFINED HYPOCHOIC AREA NOTED IN SUBCUTANEOUS PLANE WITH SURROUNDING REACTIVE LYMPHNODES, FEW SHOWING LOSS OF FATTY HILUM AND SURROUNDING INFLAMMATORY CHANGES IN LEFT INGUINAL REGION .

F/S/O LEFT INGUINAL ABSCESS.

FNAC FROM LEFT INGUINAL LYMPH NODE DONE ON 27-2-24 

IMPRESSION

FEATURES SUGGESTIVE IF GRANULOMATOUS NECROTISING LYMPHADENITIS POSSIBLY KOCH’s etiology

CT SCAN OF ABDOMEN ON 1/3/24:

IMPRESSION:

ENLARGED LEFT PARA-AORTIC LYMPHNODES MEASURING 28MM (SHORT AXIS DIAMETER),LEFT PARAILIAC LYMPHNODE(15MM SAD), AND LEFT INGUINAL LYMPH NODES(30 MM SAD).

PERINODAL INFLAMMATION AROUND THE LEFT INGUINAL LYMPHNODE.

SPUTUM FOR C/S:

ZN STAIN: NO ACID FAST BACILLI SEEN.

GRAM STAIN; >30 EPITHELIAL CELLS/LPF,8-12 PUS CELLS/LPF, PLENTY OF GRAM POSITIVE COCCI IN LONG CHAINS FEW PAIRS OCCASIONAL GRAM NEGATIVE BACILLI SEEN KOH MOUNT: NO FUNGAL ELEMENTS SEEN NORMAL OROPHARYNGEAL FLORA GROWTH.

Treatment Given

1. TAB AUGMENTIN 625MG PO/BD

2. TAB PAN 40MG PO/OD

3. TAB MVT PO/OD

4. TAB VIT C PO/OD

5.SYP.ASCORYL LS 2 TSP/PO/TID

ATT  STARTED FROM 2-3-2024