FEVER FOREVALUATIONDr N.Samatha,(MD)INTERNAL MEDICINE
Chief complaints• Mrs Vijaya, 31 yrs female, a House wife, Presented on 12/12/2011 with C/OFever : 2 monthsMalar rash : 45 daysHeadache : 45 days
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.
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.
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
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
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
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