FEVER FOREVALUATIONDr N.Samatha,(MD)INTERNAL MEDICINE
Chief complaints• Mrs Vijaya, 31 yrs female, a House wife, Presented on 12/12/2011 with C/OFever : 2 monthsMalar rash : ...
History of present illness Patient was apparently asymptomatic 2 months back  when she developed fever associated with ge...
History of present illness• Fever was intermittent, low grade, on and off, no  chills/rigors, associated joint pains mostl...
History of present illness• No past H/O exposure to C/O TB,mite bite,tick bite,or    exposure to rats or cats•   No histor...
Personal/family history• Mixed diet,decreased appetite,decreased sleep• Bowel and bladder habits regular• Menstrual histor...
General examination• Patient is conscious, coherent, cooperative, comfortably    sitting on bed, well oriented to time, pl...
Physical examination• Vitals ,BP 110/80, PR 80b/m,regular,normal    volume,character, all peripheral pulses felt.    Temp ...
Provisional diagnosisPyrexia for evaluation       ? Connective tissue disorder       ? Granulomatous disease       ? Enter...
InvestigationsCBP - HGB:10.7gm%,WBC-1,700/cu.mm, plt- 89,000,N69,M5,L10,E2PS - Normocytic normochromic,leucopenia,lympho...
InvestigationsVDRL- NRWidal test- NegativeDengue NS1 Ag &IgM, IgG -NegativeHBs Ag/Anti HAV/Anti HCV /Anti HEV- Negativ...
Criteria for SLE1.   MALAR RASH2.   Discoid Rash3.   PHOTOSENSITIVITY4.   Oral ulcers5.   Arthritis6. Renal disorder7. HEM...
DiagnosisSYSTEMIC LUPUS ERYTHEMATOSIS
ManagementSupportive therapy given,inj.methylprednisolone given,At discharge, T.azathioprine,added at 2mg/kg/day, along ...
SLE
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SLE

  1. 1. FEVER FOREVALUATIONDr N.Samatha,(MD)INTERNAL MEDICINE
  2. 2. Chief complaints• Mrs Vijaya, 31 yrs female, a House wife, Presented on 12/12/2011 with C/OFever : 2 monthsMalar rash : 45 daysHeadache : 45 days
  3. 3. History of present illness Patient was apparently asymptomatic 2 months back when she developed fever associated with generalised body pains, rash on palms,back and arms, joint pains, anorexia, sleeplessness and headache.• Patient presented to a local hospital, treated symptomatically, fever was relieved on medication and was discharged.• 10-15 days later she developed malar rash,and persistent fever.• Then, she presented to Esra hospital with fever and malar rash.
  4. 4. History of present illness• Fever was intermittent, low grade, on and off, no chills/rigors, associated joint pains mostly involving large joints[non migratory and non fleeting]• From day1 of fever, she developed macular erythema on palms, upperback and extensor aspect of arms and 10-15 days later she developed malar rash,which is slightly raised erythematous rash on cheek and nose, precipitated by sun exposure and non pruritic.• No history S/O purpura, no orogenital eruptions or scaly lesions on anyother part of the body.
  5. 5. History of present illness• No past H/O exposure to C/O TB,mite bite,tick bite,or exposure to rats or cats• No history S/O malaria,chikungunya,dengue,typhoid• No history of visual disturbances,altered sensorium & no complaints S/O motor or sensory impairment• No H/O cough or dyspnoea• No history of drug allergy• No H/O similar complaints in the past
  6. 6. Personal/family history• Mixed diet,decreased appetite,decreased sleep• Bowel and bladder habits regular• Menstrual history-menarche at 13,cycles regular,4/30,no dysmenorrhea,no clots• No similar complaints in the family
  7. 7. General examination• Patient is conscious, coherent, cooperative, comfortably sitting on bed, well oriented to time, place & person• Weight - 56kgs,BMI - 158 cms• Pallor +,no icterus no cyanosis,no clubbing,no lymphadenopathy,no pedal edema• Normal hair• Malar rash on face ,macular erythema on palms and back,non-discoid,non blanchable• No orogenital ulcers• EYES appear normal O/E• URT normal,no congestion or secretions noted
  8. 8. Physical examination• Vitals ,BP 110/80, PR 80b/m,regular,normal volume,character, all peripheral pulses felt. Temp 100F , RR 16/min• RS-BAE+,NVBS,no ADV sounds• CVS-S1,S2 heard,no murmers• P/A-soft ,no tenderness,no organomegaly,BS+• CNS-NFND,Plantars-flexor• Muskuloskeletal system examination-no swelling or redness or tenderness over large or small joints,no limitation of movements at joints,no pain,no stiffness
  9. 9. Provisional diagnosisPyrexia for evaluation ? Connective tissue disorder ? Granulomatous disease ? Enteric fever ? Malignancy
  10. 10. InvestigationsCBP - HGB:10.7gm%,WBC-1,700/cu.mm, plt- 89,000,N69,M5,L10,E2PS - Normocytic normochromic,leucopenia,lymphopeniaCUE - Pus cells-0-1,no rbc,no cystals,no castsLFT - Sr bilirubin-1.08,SGOT- 134U/L, Sr albumin- 4.3gm/dl,ALP-WNLRFT -NORMALSr electrolytes - Sr Na-146/k-3.9/Cl-100Chest xray - NormalESR -26/55mm
  11. 11. InvestigationsVDRL- NRWidal test- NegativeDengue NS1 Ag &IgM, IgG -NegativeHBs Ag/Anti HAV/Anti HCV /Anti HEV- NegativeHIV - NRUSG ABD/Pelvis - NormalANA - POSITIVE(2.975)Anti ds DNA Antibodies-positive(233IU/ml)
  12. 12. Criteria for SLE1. MALAR RASH2. Discoid Rash3. PHOTOSENSITIVITY4. Oral ulcers5. Arthritis6. Renal disorder7. HEMATOLOGICAL DISORDER8. Serositis9. Neurological disorder10. IMMUNOLOGICAL (Anti-Sm, and/or anti-phospholipid, Anti dsDNA)11. ANTINUCLEAR ANTIBODIES-ANA POSITIVE
  13. 13. DiagnosisSYSTEMIC LUPUS ERYTHEMATOSIS
  14. 14. ManagementSupportive therapy given,inj.methylprednisolone given,At discharge, T.azathioprine,added at 2mg/kg/day, along with oral prednisolone,40mg bidAt follow up, patient cell counts improved, rash faded comparatively, but complained of alopecia,GI symptoms

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