A 42 Y/O MALE WITH FEVER, HEADACHE AND GENERALISED WEAKNESS

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Consent and de-identification: The patient and the attenders have been adequately informed about this documentation and privacy of the patient is being conserved entirely. No identifiers shall be revealed throughout this piece of work. 

Chief complaints:

A 42 y/o male, farmer by occupation, presented with chief complaints of:

→ fever since 3 days

→ headache since 3 days

→ body pains since 3 days

→ generalised weakness since 3 days

History of presenting illness:

The patient was apparently asymptomatic 3 days ago,

→ then he developed a fever, which was sudden in onset, high-grade, associated with chills and rigors, and relieved temporarily on medication,

→ headache of frontal type, not associated with nausea and vomiting,

→ body pains and was unable to continue with his work,

→ generalised weakness

No h/o cough, cold, photophobia, phonophobia, burning micturition

Past history:

Not a known case of diabetes mellitus, hypertension, asthma, CAD, tuberculosis. 

Known case of leprosy with ENL

→ 2016: 

The patient developed hypoesthetic patches on both his limbs and chest, after which he went to the hospital and was given a year-long course of MB MDT which he completed. 

He developed a claw hand and trophic changes (grade II deformities) in his right hand. 

→ 2019:

The patient developed a severe erythema nodosum reaction, after which he was hospitalised again for a whole week, with the c/o high-grade fever and body pains. He was given tab. thalidomide 100mg and tab. prednisolone. 

→ 2020:

The patient underwent cataract surgery in his left eye and his right eye remains untreated. 

Right-sided hip replacement surgery. 

         

                                                    

→ 2022: 

He had a high-grade fever associated with chills and was admitted in the hospital where he was advised to stop taking thalidomide and prednisolone. 

Personal history:

Diet: mixed

Appetite: normal

Bowel and bladder movements: regular

Sleep: adequate 

Addictions: regular alcohol consumption in the past, stopped 2 years ago

Family history:

No significant family history. 

General examination:

The patient is conscious, coherent and cooperative, moderately built and nourished, and is well oriented to time, place and person. 

Pallor: absent

Icterus: absent

Cyanosis: absent

Clubbing: absent

Koilonychia: absent

Pedal edema: absent

Lymphadenopathy: absent

Vitals: 

Temperature: 102.7 °F

Respiratory rate: 22 cpm

Blood pressure: 110/90 mm Hg

Pulse: 103 bpm; rate, rhythm, volume, character normal, no radio-radial delay, no radio-femoral delay

On local examination:

multiple hypopigmented macules over the forehead, upper back and abdomen. 

B/L eyelid edema 

Peripheral nerve examination:

Peripheral nerve	Right	Left
Ulnar nerve	Thickened	Thickened
Radial cutaneous nerve	—	—
Common peroneal nerve	Thickened	Thickened
Posterior tibial nerve	Thickened	Thickened

Sensations: intact

Systemic examination: 

Cardiovascular system: 

S1, S2 heard 

No murmurs

Respiratory system: 

BAE +⃝

Trachea: central

Vesicular breath sounds heard

Abdomen:

Not tender

No palpable mass

Hernial orifices: normal 

Liver: not palpable

Spleen: not palpable

Central nervous system:

Patient is conscious 

No focal neurological deficits

Provisional diagnosis:

Pyrexia under evaluation with pityriasis versicolour 

Investigations:

Pyrexia chart:

Colour doppler 2D echo:

Ultrasound:

ECG:

Hemogram 05.01.2023:

Hemogram 06.01.2023:

Blood sugar - random:

Blood urea:

Liver function test:

Serum creatinine:

Serum electrolytes, ionised calcium:

HIV 1/2 rapid test:

HBsAg - rapid:

Anti HCV antibodies - rapid:

Glycated hemoglobin:

Blood sugar - fasting:

Lipid profile:

Post lunch blood sugar:

Dengue NS1 antigen:

Management:

→ Candid TV lotion L/A OD x 3 weeks

(20 minutes before a bath)

→ KZ cream L/A BD x 2 weeks

(face)           M -------- N

→ Tab. fluconazole 400mg stat

--------------------------------------------------------

→ Inj. NEOMOL 1 gm i.v. stat

→ IVF:

10 NS 75 ml/h

10 RL 75 ml/h

→ Tab. Pantop 40 mg OD

→ Tab. Zofer 4 mg OD

→ Inj. NEOMOL 100 ml if temp > 101 °F