35 YEAR OLD FEMALE WITH DENGUE FEVER AND ARACHNOIDITIS SECONDARY TO MENINGOENCEPHALITIS

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs".

  This E log book also reflects my patient-centered online learning portfolio and your valuable comments on comment box is welcome.

MEDICINE CASE DISCUSSION:

I've been given this case to solve in an attempt to understand the topic of "Patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

VIEW OF THE CASE:

A 35 year old woman presented to causality with the cheif complaints of fever since 1 week, cough since 1 week and vomiting since morning. 

Patient is an unmarried woman who born out of a non-consanguineous marriage,  first in order of birth and studied till 1st class. At the age of 6 years, she developed weakness and rigidity in her left upper limb and lower limb which was sudden in onset and was diagnosed as viral poliomyeilitis and taken to Tirupati for surgery.

She was on oral medication for 2 years over time she regained power in left upper limb and lower limb. She does her daily household chores on her own and takes care of herself and others.

HISTORY OF PRESENT ILLNESS:

Patient was normal to her dailylife 1 week back and she have been experiencing fever since 1 week which is of low grade, intermittent. No diurnal variations. 

She complains of cough since 3 days which is of non productive type.

She had 3 episodes of vomiting of non projectile,  non bilious, non blood stained since morning. 

PAST HISTORY:

Not a known case of diabetes, hypertension, tuberculosis, asthma.

Past surgical history: surgery to left upper limb at 5 years of age

PERSONAL HISTORY:

Appetite- normal

Diet- mixed

Bowel and bladder habits- regular

Sleep- adequate 

Addictions- no addictions 

Allergies- no allergies 

FAMILY HISTORY: Insignificant 

MENSTRUAL HISTORY: Attained menarche at 15 years of age. And her last menstrual period was on 14th October 2021.

GENERAL EXAMINATION:

Conscious coherent and cooperative 

Pallor- no pallor

Icterus- no icterus

Cyanosis- no cyanosis 

Clubbing- no clubbing 

Generalized lymphadenopathy- no generalised lymphadenopathy 

Pedal edema- no pedal edema

VITALS:

Temperature: 98.1°F

Pulse rate: 95/min

Respiratory rate: 20/min

Blood Pressure: 100/80 mm Hg

SpO2- 99% at room air

GRBS- 138mg%

SYSTEMIC EXAMINATION:

CARDIOVASCULAR SYSTEM:

First and second heart sounds heard and no murmurs.

RESPIRATORY SYSTEM:

bilateral inspiratory crepts heard in all lung fields 

PER ABDOMEN EXAMINATION:

Soft and non tender

Bowel sounds heard 

CENTRAL NERVOUS SYSTEM:

Level of consciousness- conscious 

Speech - normal

signs of meningeal irritation:

• Neck stiffness- absent
• Kerning's sign- absent 

Cranial nerves- normal

MOTOR SYSTEM:

Tone- increased in left upper limb and lower limb

Power- 

                          Right                  left

Upper limb      5                          4

Lower limb      5                          4

Reflexes-  

                        Right                     left

Biceps                2+                         -

Triceps               2+                        -

Supinator          2+                        -

Knee jerk           3+                       3+

Ankle                  +                          +

Plantar               flexion bilaterally

SENSORY SYSTEM: Normal

Cerebellar function:

• Finger nose incoordination- present 
• Knee heel incoordination- present 

INVESTIGATIONS:

ELECTROCARDIOGRAPHY:

HEMOGRAM:

ON 17TH OCTOBER 2021

Hemoglobin- 13.1g%

Total Leukocyte count- 2600

Neutrophils- 73%

Lymphocytes  - 20%

Monocytes- 6%

Eosinophils- 1%

packed cell volume- 38.6

MCV- 84.8

MCH- 28.8

MCHC- 33.9

RBC- 4.55

PLATELETS- 61000

ON 18TH OCTOBER 2021

Hemoglobin- 12.6g%

Total Leukocyte count- 3700

Neutrophils- 67%

Lymphocytes- 24%

Monocytes- 7%

Eosinophils- 2%

packed cell volume- 37.4

MCV- 86.9

MCH- 29.3

MCHC- 33.7

RBC- 4.31

PLATELETS- 40,000

RENAL FUNCTION TEST:

Urea- 39

Creatinine- 0.7

urine albumin- 3.6

Calcium - 8.8

Phosphate- 3.2

Sodium- 138

Potassium- 3.2

chlorine- 95

LIVER FUNCTION TEST:

Total bilirubin- 1.25

Direct bilirubin- 0.40

AST- 116

ALT- 44

ALP- 143

Total protein- 5.6

Albumin: globulin - 0.7

SEROLOGY:

SARS COV-2 QUALITATIVE PCR : NEGATIVE 

RAPID HBsAg: NEGATIVE 

RAPID HIV 1 & 2- NEGATIVE 

RAPID ANTI HCV ANTIBODIES-NEGATIVE 

RAPID DENGUE:

• NS1 ANTIGEN: POSITIVE 
• IgG : NEGATIVE 
• IgM: NEGATIVE 

CHEST X RAY:

ULTRASONOGRAPHY ABDOMEN:

DIAGNOSIS: 

DENGUE FEVER WITH ARACHNOIDITIS SECONDARY TO MENINGOENCEPHALITIS

TREATMENT:

1. INTRAVENOUS FLUIDS NS/RL/DNS AT 75ml/hour

2. PLENTY OF ORAL FLUIDS

3. INJ. PANTOP 40mg /IV/OD

4. INJ. ZOFER 4mg/IV/OD

5. TAB. DOLO 650mg/PO/SOS

6. IV NEOMOL 100ml/if Temperature >101°F

7. SYRUP. GRILLINCTUS 10ml/PO/TID

8. W/F BLEEDING MANIFESTATION

9. TEMPERATURE CHARTING 4TH HOURLY 

10. INPUT/OUTPUT CHARTING