A 45 year Male with Fever,Dyspnea,Burning micturation and Pain abdomen

A 45 year old male is presented with:

🌡CHIEF COMPLAINTS:

📌Fever since 1 week

📌Dyspnea since 1 week

📌Burning micturaton since 1 week 

📌Pain abdomen since 1 week

🌡HISTORY OF PRESENT ILLNESS:

📌Patient was apparently asymptomatic 14 years back.

📌 14 years back during his wife's  pregnancy on routine investigations she was found to be HIV positive. On getting tested, he turned out to be HIV positive as well. 

📌He was started on medications which he takes regularly.

📌 1 year back - he experienced pain abdomen in the right lumbar region radiating to his lower back for almost a month. 

📌He went to a local hospital and was diagnosed to have a right renal calculi for which he used medications for a couple of days and was advised to consume plenty of water.

📌Later he never experienced a similar episode.

📌Since 1 week patients has been experiencing high grade fever associated with chills,

📌 Its  more during early morning around 5 am and at midnight around 12 am.

📌 He also feels dyspneic whenever he gets these fever spikes.

📌He also has been experiencing burning micturition since a week along with pain abdomen.
 
📌His says the pain abdomen he is experiencing is similar to the one he experienced one year back, in his right lumbar region radiating to his lower back.


🌡HISTORY OF PAST ILLNESS:

📌Is a k/c/o Renal caliculi

📌Not a k/c/o DM,HTN,CAD,ASTHMA,TB 
TREATMENT HISTORY :

📌 Tab Dexa along with Paracetamol for his fever 

📌Inj. Pipatz–4 doses


🌡️PERSONAL HISTORY : .

-  Married 

- Apettite loss:No

- Micturition : Burning 

- No H/O known drug allergies

-Alcohol : Ocassional alcoholic


 ðŸŒ¡PHYSICAL EXAMINATION : 

A) GENERAL EXAMINATION :

 - Pallor- NO 

- lcterus-YES

- Cyanosis-No.  

- Clubbing of fingers/toes- No

- Lymphadenopathy-No

-Oedema of  feet- No

- Malnutrition - No

-Dehydration -NO 

- No H/O pallor, cyanosis , lymphadenopathy , clubbing of fingers or toes , dehydration,odema.

- Temperature : Afebrile 

- BP : 100/70 mmHg 

- PR : 88 BPM

- SPO2 : 99% at room air 

-RR-19 cpm

🌡SYSTEMIC EXAMINATION:

B)Per Abdomen:

-On inspection:

-Scaphoid in shape 
-Moving equally on respiration
-No scars, dilated veins 

Palpation:
-Tenderness + in right lumbar region 
-No guarding, rigidity
-No palpable mass

Percussion:
-Tympanic note+
-Auscultation:
-Bowel sounds +

INVESTIGATIONS:


Serological Investigation:

On 25/7/21(outside hospital )

ECG Findings: Regular Sinus Rythm

TLC:15,000

CUE:10-12 pus cells

USG abdomen-Right lower lobe single abscess measuring around 61*59 mm with partial liquefaction.

On 29/7/21 (In hospital)

HBsAg-Rapid: Negative 


Anti HCV antibodies:Non-reactive 




PROVISIONAL DIAGNOSIS:

1.Liver Abscess in Right lobe of Liver 
2. ? UTI
3. HIV positive

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