65 year old male with fever under evaluation.
65 year old male came to casualty with chief complaints of high grade fever with chills since 5 days.
History of present illness:
Patient what apparently asymptomatic 5 days back then he developed high grade fever with chills,continuous, subsiding with medication.
No complaints SOB,cough,burning micturition, vomitings and loose stools.
Patient was diagnosed with DM 5 years ago started on OHA.
4 years ago patient came to our hospital with c/o SOB and was told to have lung infection and ?mass and was started on insulin.
Since 4 years patient had skin lesions with scaling over legs and hands which progressed gradually,for which he used steroids and tapered.As the lesions kept progressing patient underwent skin biopsy 1month ago in outside hospital which showed munromicroabscess suggestive of psoriasis. He has been using medication for psoriasis since 1 month.
H/O unstable angina 1 and half year back-PTCA was done.
Past history:
K/C/O DM since 5 years on Inj.MIXTARD 10U(morning) and 8U(night).
Not a K/C/O HTN,TB,asthma,epilepsy, thyroid disorders.
Personal history:
Diet-mixed
Appetite-normal
sleep-adequate
Bowel and bladder movements-regular
Family history:
Not significant
General examination:
Patient is conscious, coherent, cooperative.
No pallor,icterus,cyanosis,clubbing,lymphadenopathy,edema.
Vitals on admission:
Temperature-99 F
PR-64 bpm
RR-18 cpm
BP-80/60 mmHg
Systemic examination:
CVS-S1,S2 heard,No murmurs
RS-BAE present
Crepts present in B/L IMA and IAA
CNS-No FND
P/A-soft,non tender
Provisional dignosis:
History of present illness:
Patient what apparently asymptomatic 5 days back then he developed high grade fever with chills,continuous, subsiding with medication.
No complaints SOB,cough,burning micturition, vomitings and loose stools.
Patient was diagnosed with DM 5 years ago started on OHA.
4 years ago patient came to our hospital with c/o SOB and was told to have lung infection and ?mass and was started on insulin.
Since 4 years patient had skin lesions with scaling over legs and hands which progressed gradually,for which he used steroids and tapered.As the lesions kept progressing patient underwent skin biopsy 1month ago in outside hospital which showed munromicroabscess suggestive of psoriasis. He has been using medication for psoriasis since 1 month.
H/O unstable angina 1 and half year back-PTCA was done.
Past history:
K/C/O DM since 5 years on Inj.MIXTARD 10U(morning) and 8U(night).
Not a K/C/O HTN,TB,asthma,epilepsy, thyroid disorders.
Personal history:
Diet-mixed
Appetite-normal
sleep-adequate
Bowel and bladder movements-regular
Family history:
Not significant
General examination:
Patient is conscious, coherent, cooperative.
No pallor,icterus,cyanosis,clubbing,lymphadenopathy,edema.
Vitals on admission:
Temperature-99 F
PR-64 bpm
RR-18 cpm
BP-80/60 mmHg
Systemic examination:
CVS-S1,S2 heard,No murmurs
RS-BAE present
Crepts present in B/L IMA and IAA
CNS-No FND
P/A-soft,non tender
Clinical images:
Psoriatic plaques on B/L upper and lower lims:
Investigations:
Fever under evaluation with myalgias under evaluation with low backache 2°to radiculopathy.
With H/O PTCA 1 and half year back
With K/C/O DM-type 2
Treatment:
IVF NS @150 ml/hr-bolus given
@75 ml/hr- maintenance
TAB.DOLO 650MG TID
INJ.NEOMOL 1G IV SOS
Temperature charting 4th hrly
INJ.AVIL 2CC SOS(IF CHILLS +)
GRBS monitoring 6th hrly
INJ.HUMAN ACTRAPID ACCORDING TO GRBS
TAB.ECOSPIRIN 75/20 MG PO OD
INJ.PIPTAZ 4G IV QID
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