*Re-upload of slides originally posted 16th April 2019.* Note: Uploading to SlideShare causes disruption to slide layout. Original layout visible on download. Case presentation of a patient (anonymised) seen in outpatient clinic during course of medical school studies. NOTE: Slide 7 references the patient never having had a flu vaccination due to their egg allergy. Although trivalent influenza vaccinations are grown in embryonated hens' eggs, other preparations (such as the Influenza A-specific flu vaccine) are grown in mammalian cells and are therefore safe for patients with egg allergy. Sources for all imagery and sources listed in references section where possible. I do not claim ownership of any images or graphics. Slides for educational purposes only, and should not replace clinical judgement. No monetary gain was made for this work.

1. Patient Case: M.T.
Robert Ferris

2. Presenting complaint
28 y/o female with
 Productive cough
 Fever
 Sinusitis
 Post-nasal drip
Persisting for roughly one month.

3. History of presenting complaint
 M. first developed a cough and runny nose roughly four
weeks prior to this visit
 She has had two visits to the doctor since symptoms
began, but her complaints progressed to include
symptoms of sinusitis (congestion, headache) and she
developed a fever
 She had CBC results from a prior visit, which she brought
with her

4. Medical history
 First visit to clinic in February XXXX: upper respiratory
infection, which resolved itself
 October XXXX: hip pain radiating to right leg, suspected
muscle strain, referred to physiotherapy. Symptoms
resolved with massage therapy.
 January XXXX: nonspecific gastric pain. No clear cause
on USG. Pain suspected to be caused by reflux. Patient
prescribed PPI and symptoms resolved.
 No history of chronic conditions or past surgical
procedures

5. Medications
 No longterm medications
 Over the past month she was prescribed
 Tafen (budesonide) nasal spray - corticosteroid
 ACC (acetylcysteine) – mucolytic
 Irigasin – sodium chloride nasal irrigation
 Sinupret 1,2
– supplement advertised to relieve symptoms
of sinusitis/URI
 She reported these to be ineffective

6. Family history
 Grandmother died of pancreatic cancer
 Grandfather died of MI
 Otherwise no reported history of any chronic
conditions in relatives

7. Other
 Social: Nonsmoker, drinks ETOH infrequently
 Vaccination status: immunised as a child, no
vaccinations since
 Allergies: NKDA, but allergic to egg whites (she has
therefore never received a flu shot)

8. Physical exam
 Heart rate within normal limits, regular, no abnormal/extra
sounds
 Breathing rate normal, no crackles, ronchi, wheezes
appreciable
 Temperature was 37.2 °C
 No abdominal pain, signs absent
 BP not taken. Last reading (roughly two weeks ago) was
126/79. M. has no history of hypertension, and reports no
symptoms.

9. CBC
 Patient showed largely normal CBC from previous
visit
 Only three abnormal results, all very minor:
 ↑ PLTs – elevation during infection is common, particularly
with UR infections
2
due to increased reactivity
3,4
 ↓ basophils – common in infection, level deplete due to
inflammation
 ↑ monocytes – indicates high WBC turnover, even in
absence of increase in other lymphocyte forms or total
white cell count

10. Differentials
 Bronchitis: given lack of severity on physical
exam combined with patient history showing
almost no predisposition, this is certainly not the
most likely diagnosis
 Flu: no myalgia, symptoms far too mild
 Pneumonia: extremely unlikely patient, and no
specific signs even for walking pneumo

11. Diagnosis
 Persistent URI – J06.9
 She was prescribed:
 Glimbax (diclofenac)
 Erdomed (erdosteine)
 Echinacea (herbaceous plant)
 Rutinacea (supplement)
 Vitrum D3 (VitD supplement)
 Drink plenty of water!

12. References
 Popovich V., Koshel I. (2017), Sinupret ® as add-on therapy to saline irrigation for
children with acute Post-Viral Rhinosinusitis, Clinical Phytoscience 3(10)
 Neubauer N., März R. (1994), Placebo-controlled, randomized double-blind clinical
trial with Sinupret® sugar coated tablets on the basis of a therapy with antibiotics and
decongestant nasal drops in acute sinusitis, Phytomedicine 1(3): 177-181
 Zheng S., Xiao Q., et al., (2016), Association between secondary thrombocytosis and
viral respiratory tract infections in children, Scientific Reports 6
 Assinger A. (2014), Platelets and Infection – An Emerging Role of Platelets in Viral
Infection, Frontiers in Immunology 5: 649
 Kreutz R., Tantry U., Bliden K., Gurbel P, (2007), Inflammatory changes during the
'common cold' are associated with platelet activation and increased reactivity of
platelets to agonists, Blood Coagulation & Fibrinolysis 18(8): 713-718
Thank you!
Questions?