Viral Pyrexia and Thrombocytopenia

 3/03/2022

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Sanidha Singh

Roll no.- 206

A 40 year old patient who is RTC Bus driver by occupation and a resident of Ramannapet.

Chief Complaints:

Patient complained of chills and fever since 5 days (27/02/22) and headache and neck pain since 4 days.

History Of Presenting Illness:

Patient was apparently asymptomatic 5 days ago then he had fever which was sudden in onset and continuous in nature associated with chills in the evening which relieved on taking self medication. The same symptoms continued the next day with frontal headache and lower neck pain. He then went to the local government hospital nearby where he was prescribed paracetamol tablet and an injection not known to the patient. The symptoms subsided on medication temporarily and he went home. But the next day he again had the same symptoms . He then decided to get himself checked in our hospital. After running some test he was admitted in our hospital on 2/03/22.

No h/o nausea, vomiting 

No h/o loose stools, abdominal distension

No h/o rash, cough, cold

No h/o burning miturition & dysurea

Past History:

Not a known case of HTN, DM, Thyroid Disease, Asthma, TB.

Personal History:

Diet- Mixed 

Appetite- Normal

Bowel & Bladder movement- Regular

Alcohol addiction, last binge 3 days back 60 ml Whisky

Family History:

NAD

On Examination:

Patient is C/C/C

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema.

Vitals- 

Temperature  - 98.1
Pulse Rate  - 75 BPM
Blood Pressure  - 120/80 MM OF HG 
Respiratory Rate  - 17
SPO2 - 100 % at room air 

Systemic Examination - 

Per Abdomen :  Bowel sounds present, Normal shape, No tenderness, No palpable masses

CVS : S1 & S2 Heard , No murmurs 

RS : Central position of trachea, Vesicular breath sounds, No wheeze, no dyspnea

CNS : NAD

Investigation:

HEMOGRAM
HB 14.3
TC 2800
PLT 92000
MCV 80.2
PCV 41.2
MCH 27.5
MCH 34.3
SMEAR - NORMOCYTIC NORMOCHROMIC, WITH BICYTOPENIA

SMEAR FOR MALARIAL PARASITE - Negative

BGT - O +ve

CUE
ALB - trace
Sugar - nil
Puscells - 2-4
Epithelial cells - 2-4

HbSAg - negative
HCV - negative
HIV - negative

Dengue serology
NS1 - +ve
IgG - negative
IgM - negative

RFT
Urea- 22
Creatinine-0.9
UA-4.1
Calcium-9.2
Phosphorus-2.5
Sodium-136
Potassium-3.8
Chloride-102

LFT
TB-1.37
DB-0.47
AST-84
ALT-49
ALP-168
TP-56
ALB-3.31

ECG

Normal Sinus Rhythm

Temperature Monitoring:

Treatment:

Day 1: Inj. Paracetamol 1g IV Stat

  IVF NS/RL at 75ml/hr

  T. Paracetamol 650mg PO TID

   IVF NS/RL at 150ml/hr

Day 2:  Inj. Optineuron in 100ml NS over 30 mins

             T. Paracetamol 650mg PO TID