A 23-year-old male presented with fever, chills, body pains, headache, and dysuria for one week. He has a history of ulcerative colitis treated with mesalazine and prednisone. Examination found elevated white blood cell count and numerous pus cells in the urine. He was diagnosed with a urinary tract infection complicating his ulcerative colitis. Treatment included antibiotics, antipyretics, hydration, and continuation of his ulcerative colitis medications. His symptoms improved over three days of treatment and monitoring.

1. CASE PRESENTATION
UTI with IBD-ulcerative colitis.
by
Nagaraju B
dr.bnr2011@gmail.com

2. DEMOGRAPHIC DATA
Patient Name - xxx
IP No.
- 9857/13
DOA
- 28/10/2013
DOD
- 30/10/2013
Ward
- Med-I
Age
- 23years
Sex
- Male

3. SUBJECTIVE EVIDENCE
Chief complaint/ History of Presenting illness:
 c/o fever with chills since 3 days
 c/o severe headache and generalized body
pains since 3 days
 c/o generalized weakness and fatigability since
3 days
 c/o dysuria for 1 week and it was subsided 3
days back

4. Previous history:
 h/o Irritable Bowel Disease-Ulcerative
Colitis(IBD-UC) since 3 years with on
medication,
1) Tab Mesacol 800mg (TID)
2) Tab Wysolone 25mg (OD)
 No h/o prior other comorbidities
 No h/o DM/HTN/IHD/TB/Epilepsy
Past Medication History with Allergy:
 Nothing significant

5. Personal history:
Diet- Mixed
Appetite- Decreased
Sleep- Disturbed
Bowel- Constipation+
Bladder- irregular
Habits- None
Family history:
no f/h/o DM, HTN, ASTHMA, TB

6. OBJECTIVE EVIDENCE
Physical examination:
A 23 year old male patient moderately built,
conscious, cooperative and alert.
Vital signs:
BP-120/70 mmHg
PR-84 bpm
RR-17cpm
Temp-afebrile
P[-], I[-], C[-], C[-], L[-], E[-]

7. Systems :
P/A -soft, non-tenderness.
RS -NVBS+, no additional sounds.
CVS – S1S2+, no murmurs.
CNS -HMF-N
cranial nerves-N
No sensory/motor deficit
Provisional diagnosis :
??UTI with IBD

8. LABORATORY INVESTIGATIONS:
TEST
TEST VALUE
Hb (g/dl)
TLC
(cells/cmm)
14.0
15700
NORMAL VALUE
12-16
4000-11000
DLC
N (%)
90
L (%)
07
20-45
E (%)
00
1-6
M (%)
03
2-10
B (%)
00
0-1
Platelets (cells/cmm)
PCV(%)
40-75
1.84
38.2%
1.5-4.0 lakh/cmm
42-52

9. TEST
TEST VALUE
NORMAL VALUE
Bl. U (mg/dl)
19
12-40mg/dl
Sr. Cr (mg/dl)
0.9
0.2-1.4mg/dl
Sodium (mmol/L)
134
135-145
Potassium (mmol/L)
2.9
3.5-5.0
Chloride (mmol/L)
111
96-106
Urine Microscopy
Numerous pus cells are seen
USG Abdomen
Debris in bladder is seen

10. ASSESSMENT
Based on subjective evidence[fever, body pains,
headache, dysuria, weakness and fatigability] &
objective evidence [elevated WBC count and
Neutrophil percentage, numerous pus cells in
the urine and debris has seen in the bladder as
per USG report], the patient was diagnosed to
have Urinary Tract Infection with Irritable Bowel
Disease [Ulcerative Colitis]

11. MEDICATION CHART:
BRAND NAME
GENEROIC NAME
DOSE
Inj Mikacin
AMIKACIN
Inj Febrinil
FREQUENCY
DATE
DATE
END
750mg 1-0-0
28/10
Contd/-
PARACETAMOL
125mg sos
28/10
Contd/-
Tab Dolo 650
PARACETAMOL
650mg 1-1-1
28/10
Contd/-
Tab Mesacol
MESALAZINE
800mg 1-1-1
28/10
Contd/-
Tab Wysolone
PREDNISOLONE
25mg
1-0-0
28/10
Contd/-
Inf NS
SOD CHLORIDE
2PINT
75-125ML
30/10
Contd/-

12. DATE SHEET [PROGRESS NOTE]:
First day [ 28-10-2013 ]
O/E : Pulse-84/min
BP-120/70mmHg
CVS- S1S2 +
Temp-normal
No pallor/Icterus
P/A-NAD
Advice :
Inj.Amikacin 750mg [1-0-0]
Inj.Febrinil (Paracetamol) 125mg [OD]
Tab Dolo (Paracetamol) 650mg [1-1-1]
Tab Wysolone (Prednisolone) 25mg [1-0-0]
Tab Mesacol (Mesalazine) 800mg [1-1-1]
IVF-NS 75ml /hr

13. Second day [ 29/10/2013 ]
Dysuria
Frothy urine
Advice : Inj.Amikacin 750mg [1-0-0]
Tab Dolo (Paracetamol) 650mg [1-1-1]
Tab Wysolone (Prednisolone) 25mg [1-0-0]
Tab Mesacol (Mesalazine) 800mg [1-1-1]

14. Third day [ 30/10/2013 ]
Patient feels better & CST
Advice : N.S 125mg/hr
Inj.Mikacin (Amikacin) 750mg [1-0-0]
Tab Dolo (Paracetamol) 650mg [1-1-1]
Tab Mesacol (Mesanisolazine) 800mg [1-1-1]
Inj.Febrinil (Paracetamol) 125mg sos
Tab Wysolone (Prednisolone) 25mg [1-0-0]
Syrup Potklor (Pot. Chloride) 15ml [TID]

15. PLANNING
Suggestion to Physician No drug interaction found.
 Urine culture and sensitivity tests and Blood sugar
tests might have advised.

16. Advice to Patient Adhere to medication.
 Practice good hygiene.
 Drink plenty of water and other fluids to flush the urinary
system.
 Empty bladder after sex.
 Wash your genital area or shower before sexual activity.
 Go to the toilet as soon as you feel the urge to urinate, rather
than holding on.
 Wipe yourself from front to back (urethra to anus) after going
to the toilet
 Avoid using spermicide-containing products, particularly with a
diaphragm contraceptive device.
 Wear cool cotton underwear, rather than a synthetic material
to help with ventilation.

17. THANK YOU…