36M with fever and neck swellings.

36 year old male, daily waged labourer by occupation presented with cheif complaints of 

Fever since 1 week

Pain abdomen since 4-5 days

Burning micturation since 4-5 days

Yellowish red coloured urine since 4-5 days

Patient was apparently normal 14 years back, when he used to smoke 1 pack of beedies per day during his daily works like farming, then one day he developed shortness of breath on exertion which gradually progressive over days to limit his daily routine works. Then he visited near by hospital and told that he had fluid in Rt side of the lung ( nimmu : in patient words) no fluid was removed and told it is beacuse of smoking and treated conservatively after few days symptoms resolved.

4 years back he had a snake bite at right leg.

2 years back he had head injury in a fight with relatives due to financial issues and 6 sutures was placed. 

1 week back he developed Fever which is high grade associated with chills mostly in nights with sweating,. Continous type , relived with medication.

2 days later he observed a small swelling at left side of his neck initially very small and progressed over 3-4 days to present size and increased in number.

Lymphnodes are mobile, Multiple with both sides of neck and in left inguinal region which are painful on palpation and non tender with firm in consistency. No discharging tracts seen.

Since 3-4 days patient developed pain abdomen continous type in Rt hypochondrium, epigastrium and umbilical area, Associated with heaviness in the chest, no nausea, vomitings, loose stools. No constipation, passing stools and flatus.

He also had burning micturation with reddish yellow in colour since 2-3 days.

No H/O recent travel or outside food intake

No H/O exposure to pets like cat, dog

No H/O sore throat

Personal history: 

Sleep adequate when no fever

Appetite lost

Bowel and bladder movements normal

Patient is occasional alcoholic since with 90 ml of whisky twice to thrice weekly since 5 years.

Smoker since 5 years daily 3-4 cig.

Patient reported that he observed he feels generalised body itching sensation when ever he eats chicken, rosella ( gongura, hibiscus sabdariffa) since 2 years it was so severe that last year he used to take 1-2 tablets in week but this year he is taking when ever he eats above food everytime.

General examination:

Patient consious, coherent, cooperative

Moderatly built and we'll nourished.

Pallor: absent 

Icterus: absent 

Cyanosis : absent 

Clubbing : absent 

Lymphadenopathy : cervical and inguinal

Edema : absent 

Vitals:

 Temperature: 105F

 Pulse: 110 bpm

 Blood pressure:110/80 mm of hg

 Respiratory rate : 20 bpm

SpO2 : 98 on RA

GRBS : 147 MG/DL

Systemic examination:

Cardiovascular system  

JVP - not raised

Visible pulsations: absent 

Apical impulse : left 5th intercostal space in midclavicular line.

Thrills -absent 

S1, S2 - heart sounds heard 

Pericardial rub - absent

Respiratory system:

Patient examined in sitting position

Inspection:-

oral cavity- Normal ,nose- normal ,pharynx-normal 

Shape of chest - normal

Chest movements : bilaterally symmetrical

Trachea is central in position.

Palpation:-

All inspiratory findings are confirmed

Trachea central in position

Apical impulse in left 5th ICS, 

Chest movements bilaterally symmetrical 

AUSCULTATION 

B/L lungs clear 

Abdomen examination:

INSPECTION

Shape : distended ( fat )

Umbilicus: normal 

Movements :normal

Visible pulsations :absent

Skin or surface of the abdomen : normal 

PERCUSSION- tympanic note 

AUSCULTATION :bowel sounds heard

CNS : 

E4V5M6

B/L Pupils NSRL

Hmf intact

Cranial nerves normal

No Neck stiffness 

No kernigs 

All 4 Limbs tone and power normal.

Sensory system - pain, temp intact.

Rombergs - swaying present.

Labs : 

Usg neck : 

Fever chart : 

Diagnosis : 

Fever with cervical lymphadenopathy 

Management :