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35 year old man with childhood paralysis after fever and current weight loss and body swelling since 2 years

Patient name :   BARLERIA462PRIONITIS



History sent by faculty Gandhi Medical College, Bhopal to our Global Telemedicine-UDHC  email network:
Date: Fall 21, 2013

35 yr M known patient of (Paralysis since 7 months after birth (that developed after a febrile illness--edited)

+ed with vomiting, weakness, fever ,cough since 3 days (acute on chronic)

 Chronically malnourished and debilitated (wasting + and reduce skin fold thickness...attached video)

Weight-35 kg (50kg 2 years before)

Gradually decreasing appetite and evening rise of fever(as reported)

NO AFB DONE

Pedal edema+nt (pitting/localize)-DUE TO LONG RECUMBENT POSITION  OR NUTRITIONAL??????

Serum Albumin-2.2 A/G ratio-0.6

(NUTRITIONAL DEPRIVATION?????)

LFT- other parameter within the normal range

RFT- urea was 59 on 19th September ; 39 today(with  in normal)

Serum Creatinine and electrolytes- with  in normal range

Hb-8.4  RBC count-2.11 million/cumm  Total WBCs-7600/cumm ,Neutrophil-93%

Microcytic hypochromic picture

Urine microscopy-n  apart from Ca Oxalate crystal +NT

Tachypnea (rr-44/min) CXR shows effusion rt side with consolidation ,(Cavitary lesions +)(please provide your comment on finding)

Bladder and bowel ? enema given yesterday

USG abdomen shows dilated bowel loop with slow peristalsis at right flank

XRay KUB- dilated bowel loop ?????

Attaching some documents

Probably the patient will be visiting you on Monday. His parents are concerned  as doctors are saying that he is suffering from some 'serious' illness.

regards,

Faculty
Gandhi Medical College, Bhopal

Responses from the UDHC telemedical network even before the patient presents to PCMS, Bhopal


From: Aakriti Pandita USA
Fall 2013

AFB needs to be done immediately. Also, possibility of abdominal tuberculosis to be ruled out. It may also be bacterial infection superimposed on tuberculosis. So, care should be taken not to give any antibiotic, especially fluroquinolones till TB is ruled out. Any CNS symptoms? like altered sensorium/ neck stiffness/ seizures? I feel its important to rule out disseminated TB in this case.

Thanks,
Aakriti

From: Deepanjan Bhattacharya, Kolkata
Fall 2013
CXR - rt side only 4 ribs can be counted, is liver dullness elevated? Liver should be enlarged (LFT should be done if liver enlarged)
Sputum for AFB, Mantoux test should be done
urine for albumin should be done to rule out nephrotic syndrome
Urea/Cr ratio indicates a prerenal type of renal failure. BP???

A trial of ATD should be started as it is looking like a case of pulmonary TB from clinical point of view (although results of respiratory system examination are not available)

Deepanjan


History in Hindi (in the patient's own language) uploaded by Ms Anamika Sharma, PCMS Medicine, Research Lab, Bhopal, Fall 2013"

Patient Particulars - Age - 35 Height - 5' 1''; Weight - 38kg;

History of Illness - jab me 7 month ka the mujhe infection ho gaya the ,uske baad high fever gaya the.fir mujhe bahut jayada weakness a gai ,or uske baad se meri sari activity slow ho gai.me 4 years ki age se mene chalna start kiya. mene bolna bhi late start kiya.
mera khana peena bhi teek the.me jayadatar liquid khana hi khata hu.me apne bhi kapde bhi nahi pehan pata hu.or mujhe circkit dekhna mujhe bahut achha lagta hai.


2010 se meri diet kam ho gai.aur weight bhi 50 kg. se 35 kg.wajan kam ho gaya.or abhi september me mujhe  people's  hospital me addmit kar diya gaya.medicine lene se vomitting bhi or fever bhi kam ho gaya.


Output posted here: http://www.udhc.co.in/SOLUTION/viewSolution.jsp?topic_id=844&solution_id=88


Patient was diagnosed as hypoalbuminemia due to nutritional deprivation (after a psychological change following relocation to another city 2 years back). His Cardiovascular (on 2D Echo), Liver (On USG) and Kidneys (on urine albumin) were grossly normal.

A diet chart along with optimal protein and calories was advocated in an attempt to restore his weight. The parents were also counseled to keep the patient mobilized and active through their own involvement with him.

They have been also asked to update the patient's status weekly in this site.

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