30Y/M viral pyrexia with thrombocytopenia

CASE:

A 30 year old male farmer by occupation, presented to the OPD with chief complaints of fever since 1 week, generalised weakness and pain abdomen since 3 days and reduced appetite since 2 days.

History of presenting illness:

Patient was apparently asymptomatic 1 week back. Then he developed a low grade fever which was intermittent in nature 1 week ago which reduced with medication.

He also complains of generalised weakness and pain abdomen in the periumbilical region since 3 days and reduced appetite since 2 days.

No H/O vomiting, loose stools, cough, SOB, burning micturition, or any other complaints. 

Past history:

No H/O DM, HTN, asthma, TB, CAD, epilepsy

No surgical history

Personal history:

Consumes mixed diet

Appetite reduced since 2 days

Bowels regular

Micturition: abnormal- high coloured urine

Addictions: alcoholic since 5 years

Family history:

Mother is hypertensive. 

General examination:

Patient is conscious, coherent and cooperative

Moderately built and nourished

Vitals:

Temp: 99 F

PR: 96bpm

BP: 90/60mmHg

RR: 18cpm

Systemic examination:

CVS:S1 S2 heard

RS: BAE+ NVBS+

P/A: shape-obese, tenderness present in the epigastric region, no organomegaly

CNS: NFND

Investigations:

Prior to admission:

Hemogram: 

Hb: 18 gm/dL

TLC: 6,200 cells/cu mm

Neutrophils: 49%

Lymphocytes: 40%

RBC: 6.49 millions/cu mm

Platelets: 32,000 cells/cu mm

CUE:

Albumin: +++

Sugars: nil

PC: 3-4

EC: 2-3

RBC: nil

Serum creatinine: 1.2 mg/dl

RBS: 121 mg/dl

Day-1:

Rapid Dengue:

NS1: negative

IgM: negative

IgG: negative

Hemogram:

Hb: 14.9 gm/dl

TLC: 7,700 cells/cu mm

Neutrophils: 30%

Lymphocytes: 60%

RBC: 4.75 million/ cu mm

Platelets: 30,000 cells/ cu mm

LFT:

Total bilirubin: 1.32 mg/dl

Direct bilirubin: 0.41 mg/dl

SGOT: 75 IU/l

SGPT: 19 IU/l

ALP: 230 IU/l

Total protein: 5.1 gm/dl

Albumin: 2.5 gm/dl

A/G: 1.30

Serum creatinine: 0.9 mg/dl

Serum electrolytes:

Na: 130 mEq/l

K: 3.9 mEq/l

Cl: 98 mEq/l

ECG:

USG: 

Gall bladder wall edema

Moderate ascites

Provisional diagnosis:

Viral pyrexia with thrombocytopenia 

Treatment given:

1. IVF: NS, DNS & RL @100ml/hr continuous infusion

2. Inj. PAN 40 mg/IV/OD

3. Inj. OPTINEURON 1 amp in 100 ml NS/IV/OD

4. Tab. PCM 650mg/TID.   1-1-1

5. Watch for bleeding manifestations 

6. Inj. NEOMOL 1gm/IV/SOS if temp > 101 F

7. Monitor PCV, platelet count 12th hourly

8. Strict I/O charting

Day-2

1. IVF: NS, DNS & RL @100ml/hr continuous infusion

2. Inj. PAN 40 mg/IV/OD

3. Inj. OPTINEURON 1 amp in 100 ml NS/IV/OD

4. Tab. PCM 650mg/TID.   1-1-1

5. Watch for bleeding manifestations 

6. Inj. NEOMOL 1gm/IV/SOS if temp > 101 F

7. Monitor PCV, platelet count 12th hourly

8. Strict I/O charting

Day-3 

Subjectively- No fever spikes. C/o abdominal distension. 

Objectively- c/c/c. 

Temp: 98.6 F

PR: 58 bpm

BP: 140/90 mm Hg

CVS: s1s2

RS: BAE + NVBS +

CNS: NFND.

P/A: abdomen distended. Soft, non tender. 

Assessment- viral pyrexia with thrombocytopenia. 

Plan- 

IVF - NS, RL, DNS @ 150ml/hr

Inj PAN 40 mg IV/OD

Inj. Optineuron 1 amp in 100 ml NS IV/OD

Tab. PCM 650 mg BD

Watch for bleeding manifestations

Strict I/O charting

Vitals monitoring