thrombocytopenia and pyrexia in 52 year old male

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Case:

A 52 year old male who is a toddy collector by occupation and resident of Nalgonda came to OPD on 8/6/22 with the chief complaints of fever since 4 days,
decreased appetite since 3days,
tightness of abdomen since 3days.

History of present illness:

-Patient was apparently asymptomatic 4 days ago. He then developed fever of low grade, sudden in onset, gradually progressive and relieved on medication. 
-He also had complaints of abdominal distension which was gradual and progressive in nature. It is associated with pain. Abdominal pain aggravated on intake of liquids, solids. 
- abdominal tightness is also present. 
-Patient then approached local RMP and was given medication for 4 days. But symptoms recurred the next day. 

No history of rashes ,bleeding tendencies
No history of headache ,vomitings, generalised body pains
No history of loose stools , pain abdomen
No history of weight loss
Past history- 
      Not a k/c/o DM ,HTN, TB,ASTHMA,cva, cad

 Personal history :
  Diet :mixed 
  Appetite : normal
  Sleep : adequate
  Bowel and bladder movements:regular
  Occasional alcoholic & toddy intake

Family history :
  Not significant 

General examination:
Patient is consious, coherent, cooperative.
No signs of icterus, pallor,clubbing, lymphadenopathy, edema.

 Vitals: 
Temp: 98.6 F
PR: 84 bpm
RR: 20 cpm
Grbs: 115 mg/dl
Spo2: 98%


Systemic examination
 Per Abdomen 
Inspection:
Skin - smooth (scar from childhood)
Shape - distended
Umbilicus - normal
Abdominal wall movements - present
No visible pulsations and peristaltic movements seen. 
Palpation:
Tenderness - mild
No rise of temperature
Liver - not palpable
Spleen - mild palpable 
Gall bladder - not palpable
Kidneys - not palpable

Percussion: 
Liver - dull note
Spleen - dull note
No shifting dullness, fluid thrill. 

Auscultation:
Bowel sounds heard.
No bruit. 

CARDIOVASCULAR SYSTEM- 

Inspection- 
The chest wall is bilaterally symmetrical.
No dilated veins, scars or sinuses are seen
Apical impulse or pulsations can be appreciated in sixth intercostal space 2cms lateral to mid clavicular line

Palpation-
Apical impulse is felt in the sixth intercostal space, 2 cm away from the midclavicular line
No parasternal heave or thrills are felt 

Percussion- 
Right and left borders of the heart are percussed 

Auscultation-
S1 and S2 heard, no added thrills and murmurs are heard

 RESPIRATORY SYSTEM-  
Inspection-
Chest is bilaterally symmetrical
The trachea is positioned centrally
Apical impulse is not appreciated 
Chest moves normally with respiration
No dilated veins, scars or sinuses are seen

Palpation- 
Trachea is felt in the midline 
Chest moves equally on both sides 
Apical impulse is felt in the sixth intercostal space 
Tactile vocal fremitus- appreciated 

Percussion-
The areas percussed include the supraclavicular, infraclavicular, mammary, axillary, infraaxillary, suprascapular, infrascapular areas.
They are all resonant.

Auscultation-
Normal vesicular breath sounds are heard


Central nervous system: 
No abnormalities detected

INVESTIGATIONS

Hemogram:
      Hb-14.9
       TLC-10,500
       N-43
        L-48
       E-01
      RBC-5.02
      PLT-22,000

Blood urea-59
Serum creatinine-1.6
 Serum Electrolytes-
    Na+ :141
    K+    :3.9
    Cl-   :103

 LFT
    Total bilirubin -1.27
     Direct bilirubin -0.44
     SGOT-60
     SGPT-47
      ALP-127
      Total protein-5.9
      Albumin-3.5
      A/G ratio-1.48
 CUE
    ALbumin- ++
    Pus cells -4.6
    Epithelial cells:2-3

USG :
Fatty liver (grade 2)
Mild splenomegaly
Mild pleural effusion in right lungs

 Provisional diagnosis: 
 -viral pyrexia with thrombocytopenia




O/E :
  Pt is conscious,coherent ,cooperative
Temp: 103 F 
Bp: 120/ 70mmhg
Pr: 90 bpm
RR: 24 cpm

SYSTEMIC EXAMINATION:

CVS:
  S1, S2 heard. No murmurs heard. 

RS: 
   Bilateral air entry present

Per abdomen:
 Soft, mild tenderness
 Shape: distended
 Bowel sounds heard.

 Treatment
On 13th 
Oral fluids 
Tab dolo 650 mg/po/sos
Tab pan 40 mg 
Doxycycline 100 mg 
Zincovit 
8th hourly monitoring of vitals 







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