13 YEARS OLD MALE WITH C/O OF SWELLING OVER NECK AND FEVER
MEDICAL CASE
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December 13 2021
YOGITA AILANI
Roll no:149
CASE DISCUSSION
13/M WITH SWELLING OVER THE NECK AND FEVER
HISTORY OF PRESENT ILLNESS
Patient was apparently asymptomatic 20 days back then in hostel he had epigastric burning type of pain not a/w vomitings or loose stools. He has a pet (cat) used to play with it daily. 12 days back patient noticed swelling over right side of neck initially very small which progressed to present size. Since 10 days patient developed fever, high grade,continuous type associated with body pains and malaise.
No vomitings, no loose stools, no burning micturition , no cough, no sore throat.
PAST HISTORY
Not a K/C/O DM/HTN/TB/Epilepsy/Asthma
No H/O similar complaints in the past.
PERSONAL HISTORY
Diet - mixed
Appetite - normal
Sleep - normal
Bowel habits - regular
Micturition - normal
FAMILY HISTORY
No similar complaints in the family
CLINICAL IMAGES
GENERAL EXAMINATION
Patient is conscious, coherent, cooperative, moderately built and nourished.
Pallor present
No icterus, cyanosis,clubbing,lymphadenopathy, edema
VITALS
Temp. - 103 degrees F
PR - 122 bpm
RR - 20 cpm
BP - 130/70 mmHg
SpO2 - 99% at RA
SYSTEMIC EXAMINATION
CVS - S1, S2 heard , No murmurs
RS - B/L Air Entry +
P/A - Soft, Non tender
CNS - NAD
PROVISIONAL DIAGNOSIS
Fever with cervical lymphadenopathy
INVESTIGATIONS
ECG
USG
CXR
Hb: 12.1
TLC: 9200
N: 72
L: 22
E: 02
M: 04
B: 0
SMEAR: Normocytic,normochromic,Anemia
CUE:
Albumin: ++
Pus cells: 4-5cells/HPF
MALARIA: -ve
DENGUE:-ve
RTPCR(COVID-19):-ve
LFT:
TB:1.30
DB:0.22
SGOT:31
SGPT:24
ALP:273
PROTEINS: 6.5
ALBUMIN: 2.3
TREATMENT
On 12/12/21
S :
Patient subjectively feels better.
C/ O Fever yesterday night - 99 degreee F
1 episode of vomiting
O:
Pt is conscious, coherent and cooperative
BP : 110/70 mm Hg
PR : 98 bpm
Temp : 98.6 degrees F
SpO2 : 99% @ RA
CVS : S1S2 + , No murmurs
RS : BAE +
P/A : Soft , Non tender
CNS : NAD
A :
Fever with cervical lymphadenopathy (?Cat scratch disease/Viral pyrexia with cervical lymphadenopathy)
P:
1.Inj PCM 450 mg /IV in 100 ml NS /IV/SOS if temp > 102 degree F
2.IV Fluids - NS and RL @ 100ml/hr
3. Tab . Doxycycline 100mg PO/BD
4. Tab. Azithromycin 500 mg PO/OD
5. Tab. Dolo 500 mg PO / TID
6. Tab. PAN 20 mg PO / OD
7. Plenty of oral fluids
8. BP/PR/Temp charting
9. Tepid sponging SOS
10. Strict I/O monitoring
On 13/12/21
S :
Patient subjectively feels better and is active.
No fever,vomitings.
O:
Pt is conscious, coherent and cooperative
BP : 100/70 mm Hg
PR : 88 bpm
Temp : 97.6 degrees F
SpO2 : 99% @ RA
CVS : S1S2 + , No murmurs
RS : BAE +
P/A : Soft , Non tender
CNS : NAD
A :
Fever with cervical lymphadenopathy (?Cat scratch disease/Viral pyrexia with cervical lymphadenopathy)
P:
1.Inj PCM 450 mg /IV in 100 ml NS /IV/SOS if temp > 102 degree F
2.IV Fluids - NS and RL @ 100ml/hr
3. Tab . Doxycycline 100mg PO/BD
4. Tab. Azithromycin 500 mg PO/OD
5. Tab. Dolo 500 mg PO / TID
6. Tab. PAN 20 mg PO / OD
7. Plenty of oral fluids
8. BP/PR/Temp charting
9. Tepid sponging SOS
10. Strict I/O monitoring
On 14/12/21
S :
Patient is active and has no complaints and is feeling better.
No fever,vomitings.
O:
Pt is conscious, coherent and cooperative
BP : 100/70 mm Hg
PR : 92 bpm
Temp : 97.6 degrees F
SpO2 : 99% @ RA
CVS : S1S2 + , No murmurs
RS : BAE +
P/A : Soft , Non tender
CNS : NAD
A :
Fever with cervical lymphadenopathy (?Cat scratch disease/Viral pyrexia with cervical lymphadenopathy)
P:
1. Tab . Doxycycline 100mg PO/BD
2. Tab. Azithromycin 500 mg PO/OD
3. Tab. Dolo 500 mg PO / SOS
4. Tab. PAN 20 mg PO / OD
5. Plenty of oral fluids
6. BP/PR/Temp charting
7. Tepid sponging SOS
8. Strict I/O monitoring
On 15/12/21
S: Patient is feeling better and is active
No fever,vomitings.
O:
Pt is conscious, coherent and cooperative
BP : 110/70 mm Hg
PR : 96 bpm
Temp : 97.6 degrees F
SpO2 : 99% @ RA
CVS : S1S2 + , No murmurs
RS : BAE +
P/A : Soft , Non tender
CNS : NAD
A :
Fever with cervical lymphadenopathy (?Cat scratch disease/Viral pyrexia with cervical lymphadenopathy)
P:
1. Tab . Doxycycline 100mg PO/BD
2. Tab. Azithromycin 500 mg PO/OD
3. Tab. Dolo 500 mg PO / SOS
4. Tab. PAN 20 mg PO / OD
5. Plenty of oral fluids
6. BP/PR/Temp charting
7. Tepid sponging SOS
8. Strict I/O monitoring
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