32 year old male with fever under evaluation

32 year old male patient came to casualty with chief complaints of:

Fever since 3 months

Cough since 3 months

Vomitings since yesterday 

History of present illness :

Patient was apparently asymptomatic 3 months back,then he developed fever which was of high grade associated with chills,continuous,more during night time.

C/O cough since 3 months,dry,no hemoptysis. 

Associated with shortness of breath. 

H/O weight loss present. 

H/O loss of appetite present. 

H/O paraplegia 3 months back,admitted, recovered with in 2 months.No bladder and bowel involvement. 

Past history:

H/O koch's 5 years back,used ATT for 4 months and stopped.

H/O multiple suicide attempts present. 

Not a k/c/o DM,HTN,asthma,epilepsy,CAD.

Personal history :

Diet-mixed

Appetite-normal 

Sleep-adequate 

Bowel and bladder movements-regular

Alcoholic, stopped 1 and half year back

Smoking 1 pack/ day

General examination:

Vitals on admission:

Temperature-98.8 F

BP-100/80mmhg

PR-88 bpm

RR-17 cpm

Systemic examination:

CNS               Right           left

Power

Upper limb    5/5             5/5

Lower limb    3/5             3/5

Reflexes 

Biceps            +2               +2

Triceps            -                   -

Supinator        -                   -

Knee                -                   -

Ankle               -                   -

Plantar        flexor           extensor

Thenar muscle atrophy present 

Investigations:

Sputum AFB-positive 3+

Treatment:

1)Tab.PCM 650 mg PO/TID

2)Temperature charting 4th hrly

3)Inj.Optineuron 1 amp in 100 ml NS/IV/OD