35Y/M with c/o dry cough, SOB grade ll, nausea and with h/o hemoptysis.

A 35Y/M WITH c/o dry cough , SOB grade II, nausea and with h/o hemoptysis.

April 08, 2022

April 8th, 2022

CBBLE UDHC SIMILAR CASES 

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A 35 year male, driver by occupation, came with complaints of dry cough, grade II sob, nausea and with h/o hemoptysis.

History of presenting illness: 

A 35 year male with h/o dry cough, episode of hemoptysis, low grade fever, grade II sob (17/3/22), 

was admitted at yashodha hospital on 17/3/22 and diagnosed as:

- AKI on CKD - was dialysed 4times and advised for maintenance HD.

- LRTI - B/L non homogeneous opacities on xray - edema with superadded infections (on HRCT chest).

- Sepsis MODS.

then patient was discharged on 28/3/22.

CREATININE- 11   @admission

                          - 9   @discharge

USG - grade II RPD, CMD near complete lost, 

          - size - 9X3cm (Right)

                     - 8X3cm (Left)

2D ECHO- LV RWMA, EF:42%

Pt was asked to come for review after 1 week but pt didn't do due to personal reasons and came here for MHD.

presently c/o dry cough +, SOB grade II, Nausea +,

 hemoptysis  subsided.

No c/o reduced urine output, pedal edema , facial puffiness.

OUTSIDE INVESTIGATIONS: 

S.C3 AND C4 - NORMAL, 

ANTI GBM - NEGATIVE

ANCA - C, P-ANCA - NEGATIVE

CUE: ALB 3+, 24HR PROTEIN - 1.26gms, RBC - 15-20/hpt

ANA - NEGATIVE,  RENAL BIOPSY L.M Chronic tubulointerstitial inflammation.

comorbidities- Denovo HTN ( diagnosed 20days ago), non DM,  non CAD.

BAL fluid - 

AFB - NEGATIVE, 

C/S - No growth, 

fungal c/s - candidia albicans sensitive to voriconazole, flucanozole, capsi fungin , micofungi

PAN fungal DNA - POSITIVE

DNA QUALITATIVE:

Aspergillus niger - low positive

Aspergillus fumigatus, flavus - negative

Aspergillus mucoralesps - negative

Mycobacterium - negative

PAST HISTORY:

N/k/c/o DM , BA, EPILEPSY.

PERSONAL HISTORY:

HABITS: OCCASIONAL TOBACCO USE

He follows a mixed diet. 

Appetite -Normal,

Bladder movements- normal 

Bowel movements- Normal . 

Sleep- Adequate.

FAMILY HISTORY: No significant family history.

GENERAL EXAMINATION : 

patient is conscious ,coherrent, co operative and well oriented to surroundings. He is moderately built and nourished. 

Mild Pallor ,no cyanosis, no icterus, no lymphadenopathy. 

Vitals:

Temperature: 99.8

Pulse rate: 112 beats / min.

 Respiratory rate: 36 cycles / min.

 Bp: 220/140 mmhg

Spo2: 94@RA

Grbs: 104mg/dl

SYSTEMIC EXAMINATION:

CVS: S1S2 heard, Apex 5th ICS, 1/2 inch lateral to mid clavicular line.

RS: BAE+, B/L crepts +

P/A: Soft, Non-tender

CNS: NAD

INVESTIGATIONS:

(8/4/22)

RBS-90MG/DL

HB-9.8

TLC-11,500 (87%N)

PLT-2.67

CUE: ALB - +, SUGARS - NIL, RBC - NIL

ABG: PH: 7.32, PO2: 79.1, PCO2: 13.6, HCO3: 6.9, ST.HCO3: 11.4, O2 sat: 93.5.

LFT: TB-2.44,DB - 0.56, AST -13, ALT- 10, ALP- 236, T.P- 6.2, ALB- 3.42, A/G: 1.23.

RFT- UREA: 182, CREAT: 8.7, URIC ACID: 9.4, Ca: 9.9, PO4: 7.2, Na: 139, k: 4.5, cl: 105.

SEROLOGY: NEGATIVE.

(9/4/22)

HB-9.6

TLC-8,800 (78%N)

PLT-2.55

ABG: PH: 7.49, PO2: 73.1, PCO2: 29.5, HCO3: 22.7, ST.HCO3: 24.3, O2 sat: 94.6.

LFT: TB-2.90, DB - 0.63, AST -12, ALT- 9, ALP- 221, T.P- 5.9, ALB- 3.51, A/G: 1.15.

RFT- UREA: 125, CREAT: 6.2, URIC ACID: 6.3, Ca: 9.9, PO4: 5.5, Na: 144, k: 3.7, cl: 103.

(10/3/22)

HB- 10.3

TLC- 12,000 (78% N)

PLT- 2.94

RFT- UREA: 151, CREAT: 7.5, URIC ACID: 7.6, Ca:8.0, Po4: 7.0, Na: 140, k: 4.0, cl: 9.8

ABS EOSINOPHIL COUNT: 240

(11/3/22)

HB: 9.6

TLC: 10,300 (83%N)

PLT: 2.78

RFT- UREA: 91 CREAT: 5.1 URIC ACID: 4.6 Ca: 10 Po4: 4.9 Na: 146 k: 3.9 cl: 97

FERRITIN- 889.7 ng/ml

(12/3/22)

HB: 9.7

TLC: 11,000 

PLT: 2.97

RFT- UREA:133 CREAT:6.4 Na: 140 k: 3.9 cl: 97

SR.IRON: 79

DIAGNOSIS: 

CHRONIC RENAL FAILURE (? CHRONIC TUBULO INTERSTITIAL DISEASE)

? FUNGAL PNEUMONIA (? RESIDUAL PNEUMONIA)

? CARDIOGENIC PULMONARY EDEMA 2° to HFpEF(2° to HTN)

 TYPE 1 RESPIRATORY FAILURE, HTN +

TREATMENT:

1) INJECTION LASIX 40 MG IV TID TAB.

2)TAB. PAN 40MG PO/OD 

3)TAB. ZOFER 4 MG PO/BD 

4)TAB.NODOSIS 500 MG PO/TI D 5)NEBULIZATION .IPRAVENT&BUDECORT INH BD

6)SYRUP GRILLINCTUS 10 ML PO/TID

7)TAB.MONTEK -LC PO /BD

8)INJ. EPO 4000IU S.C WEEKLY ONCE

9)IN.IRON SUCROSE 200MG +100ML NS WEEKLY ONCE 

10) T.NICARDIA 20MG PO BD

11) T.ARKAMINE 0.1MG PO BD

12)TAB.CARDIVAS 3.125MG PO /BD

13)TAB.ECOSPRIN-AV 75/20MG PO/HS

14)I/O CHARTING,TEMP CHARTING

15)TAB.DOLO 650 MG PO/SOS (IF FEVER )

16)INJ.NEOMOL 1GM IV /SOS (IF FEVER >101°F