19 year male with pyrexia

A 19year old male came to the opd with complains of fever since 30 days.C/O SOB since 15 to 20 days

HOPI:


Patient was apparently asymptomatic 1 month ago then he developed lowgrade intermittent type of fever which aggravated since 15 days, mainly during the night time,temporarily relieved on medication.It was associated with bodypains and headache, low backache.Not associated with cold and cough, burning micturition and rash on body.He complains of SOB since 15 days which is present even on rest,which aggravates after having food.Bloating and chesttightness are present.

Cold is present since 3months after drinking softdrinks/colditems.

PAST HISTORY

N/K/C/O DM, TB, epilepsy, CVA, CAD, thyroid disorders and bronchial asthma.



FAMILY HISTORY:

Not significant

PERSONAL HISTORY: 

Diet :Mixed

Apetite:Normal

Bowel and bladder Movements:Regular

Sleep:Adequate

No allergies 
Addiction: 1 beer bottle occasionally

Daily routine: Patient wakes up at 7AM and has some breakfast at 8:30AM and goes to college at 9AM.He skips his lunch.He comes back from college at 5 PM and eats some food at 6:30PM.He goes to play till 8pm.He skips dinner.He studies till 10pm for 2 hours.He sleeps by 11am.

He goes to college regularly despite his fever but 15 days back he could not eat properly due to SOB while eating.

His dailyroutine is not changed due to his symptoms but he is unable to play outdoor sports due to shortness of breath.

GENERAL EXAMINATION:

On examination patient is conscious, coherent, cooperative 

No pallor, icterus, cyanosis, clubbing,
lymphadenopathy, edema 

VITALS:

Temp-Afebrile

PR-64bpm 

RR: 22Cpm 

BP:110/70mm Hg 

Spo2:99% at room air 

GRBS charting: 98mg/dL


Systemic examination:

Per abdomen:

Soft,Nontender

RS:

bilateral air entry is present.

Normal vesicular breath sounds are heard.

CVS:

S1S2 heard.No murmurs

CNS: 

HMF+,NFND

Investigations:

Hemogram:

CUE


LFT

Peripheral smear

Reticulocyte count

RFT


ECG

Chest x ray


Serology:negative
BGT:B+ve
RBS:79mg/dl
Widal test negative
Rapid dengue negative
Blood for MP strip test negative 


Clinical image






Provisional Diagnosis:
Immune thrombocytopenia 
Viral pyrexia under evaluation

Treatment

Tab dolo 650 mg / PO/TID
Monitoring vitals 4th hourly
Tab MVT PO/OD/2PM
Tab ultracet PO/QID

My interpretations
-Giant platelet could suggest idiopathic thrombocytopenic purpura
 Postive findings 
- normal RBC smear
- WBC count within normal range
- thrombocytopenia

Differential diagnosis 
Another finding could be Bernard soulier syndrome
- postive findings in the patient includes
Thrombocytopenia
Giant platelet
Bleeding gums
Prolonged bleeding time
But it is a rare inherited disorder

My learning experience

Hematology is like diving into an ocean. The more deeper we go.. more interesting it gets.
Previously in my 3rd and 5th semester of my MBBS course my knowledge about hematology was only limited to hypoproliferative disorders like iron deficiency anemia.
Presently in 8th semester,after examining alot of patients, finally Im able to unlimit my thinking process to various other blood disorders.
It also made me realise that there are alot of literature yet to be discovered. 
This patient, a neet aspirant, kinda reminded me of the journey I started as a medical student.
After a week the patient's fever got subsided and he started doing better.



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