A 55 YEAR OLD PATIENT WITH FEVER CHEST PAIN AND LOSS OF APPETITE

January 01, 2023

 A 55 years old patient presented with fever, chest pain and loss of appetite

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 - 55 year old male, 

-farmer by occupation,  

-came to Medicine OPD with complaints of :-

 —> Chief Complaints:

-(Fever since 13 days , chest pain since 10 days, and loss of appetite since 10 days)

-History of present illness:-

—>Patient was apparently asymptomatic 8 months ago then he developed fever , cough, shortness of breath on exertion

fever is of high grade associated with chills and rigors diurnal variation ,relieved with medication 

cough was initially dry cough then progressed to productive cough with scanty sputum ( white non-bloodstained type) , not foul smelling . The sputum was more produced during night;

—>Patient was evaluated with Bronchoscopy and diagnosed with the right lower lobe aspergilloma and started on itraconazole (300mg) BD for 6 months patient was recovered symptomatically and was well till the last 13 days ;

—>13 days ago patient developed fever which was low grade, not associated with chills and rigors .

Chest pain was sudden in onset 10 days ago , pain increased with chest movements associated with SOB grade 2 progressed to grade 3

h/o orthopnea is present

no h/o of PND .

Palpitations are present ,excessive sweating is present.

patient was evaluated and found to have LV (left ventricular) strain and tall tented T waves and was treated symptomatically , loss of appetite since 10 days . Bilateral pedal oedema is present , facial puffiness is present.

- Past history:-

patient was diagnosed previously by right lobe aspergilloma on Tab itraconazole 300mg BD

No history of hypertension

No history of coronary artery disease

No history of Diabetes 

No history of tuberculosis 

No history of epilepsy

No history of asthma 

- Personal history:

-Diet - mixed

-Appetite is normal

-Bowel and bladder - normal and regular

-No Known allergies

-Addictions - occasional alcohol 2 pegs once monthly

- Family history:-

-His family members are not having any relevant issues 

 —> General examination:-

-Patient is conscious, coherent and co-operative.

-Examined in a well lit room

-Moderately built and nourished

-Icterus is absent 

-Pedal edema - present (pitting type)     

-Pallor is present 

-No cyanosis, clubbing , lymphadenopathy

                                                                                                                                                                                                      

           

                                                     

                               

                             

                    

               

                               

                                                         

                                                                                                                                 

                                                         

                                                                                                                                                                                                                                                                                                              

                                                                

 

                                                                  

                                                                     

                                                                                                                         

                                                      

     —>Vitals : -

- Temperature- febrile 

- Respiratory rate - 28 cpm

- Pulse rate - 62 bpm

- BP - 120/80 mm Hg.

- Spo2 at room air is 96%

- GRBS - 102 mg/dl

—>SYSTEMIC EXAMINATION:-

-CVS : S1 S2 heard, no murmurs

-Respiratory system : normal vesicular breath sounds heard(vesicular)

—>Abdominal examination:-

INSPECTION : -

      -Shape of abdomen- scaphoid

     -No tenderness of abdomen

• Umblicus - normal
• Movements of abdominal wall - moves with respiration 
• Skin is smooth and shiny

—PALPATION :- 

No Local rise of temperature

Tenderness absent

Guarding present

Rigidity absent 

hernial orifices normal

Fluid thrill absent

Liver not palpable .

Spleen not palpable 

Kidneys not palpable 

Lymph nodes not palpable 

—> RESPIRATORY EXAMINATION:—

—>Dyspnoea is present

wheeze is absent

position of trachea is central

normal vesicular breath sounds are heard

no adventitious sounds heard

—>CNS EXAMINATION:—

Conscious 

Speech normal

No signs of meningeal irritation 

Cranial nerves: normal

Sensory system: normal

Motor system: normal

Reflexes:      Right.           Left. 

Biceps.         ++.                 ++

Triceps.         ++.                 ++

Supinator      ++.                  ++

Knee.              ++.                 ++

Ankle              ++.                  ++

Gait: normal 

  

—>PROVISIONAL DIAGNOSIS:-

 -Right lower lobe aspergilloma

 —>INVESTIGATION:-

                                                                                             

Treatment:-

Tab DOLO 650 mg po/ TD

tab itraconazole 200mg po/BD

Tab hifenac BD

Tab Zofel