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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August 01, 2021 CHIEF COMPLAINTS Fever since 1 week Dyspnea since 1 week Burning micturition since 1 week  Pain abdomen since 1 week HISTORY OF PRESENTING ILLNESS A 45 year man, was apparently asymptomatic 14 years back.  14 years back  during his wife's  pregnancy on routine investigations she was found to be RVD positive. On getting tested, he turned out to be RVD positive as well.  He was started on medications which he takes regularly ( not documented ), he says he takes 2 tablets at night. And his wife takes one tablet at night. On asking whether their child was also RVD positive, his wife told us that their child's test came out to be negative. HIS MEDICATIONS( PATIENT)  PATIENTS  WIFE MEDICATION 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 o
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