1801006036 CASE PRESENTATION

LONG CASE

A 14 year old female , resident of nagarjun sagar came to opd with a cheif complaint of pain in both the lower limb and lower back pain since 3 days

HISTORY OF PRESENT ILLNESS

She is second born child of parents married of 3rd degree consanguinity in 2009. All trimesters were uneventful. She was delivered through Caeserean section because of delayed labour pain with birth weight of 3kg.

Immusnized till date.

2012

She was asymmtomatic upto age of 3 years, then she developed high grade fever with cough and vomittings. She was diagnosed with Sickle cell anaemia. Sickling test positive and Electrophoresis showed HbS. Blood transfusion were given 1packet.

2013

She developed high grade fever, dry cough and cold. She was diagnosed with Bronchopneumonia. X-ray lower lobe consolidation.

2015

She had recurrent episodes of fever, cough , cold i.e Recurrent Bronchopneumonia- 6 episodes in 3years. Urine culture showed Klebsiella growth.

Blood transfusion till date 4 times.

2016

She developed fever, pain abdomen , myalgia and arthralgia. She improved on medications and thus was discharged.

2019

She came with stomach pain and vomittings. She was diagnosed to have Acute pancreatitis.

2023

She was apparently asymptomatic 3 days back then she developed pain in left ankle for which she took TAB.ULTRACET and since 1 day she developed pain in both knee and after 1 hr she developed tenderness in the calf muscles it is of throbbing type in nature

No H/o of swelling

All the peripheral pulses are palpable

No h/o chest pain,shortness of breath,headache and palpitations

No h/o aphasia or dysphagia, seizures,Severe headache,altered mental status

PAST HISTORY

she is a known case of sickle cell anemia

H/o of bronchopnemonia

H/o of 8 PICU admissions

H/o of blood transfusion (20 times till now) last transfusion was done in jan 2023

No H/O of asthama,thyroid,Tuberculosis, Hypertension, Diabetes,Epilepsy

No h/o of bone pain with localized swelling

PERSONAL HISTORY

Diet-mixed

Appetite-normal

Sleep-adequate

Bowel and bladder movements are regular

No allergies

No addictions

No h/o of any surgery

FAMILY HISTORY

3rd degree consanguity of parents

No known affected relatives

IMMUNIZATION HISTORY

patient is vaccinated according to national immunization schedule

Pneumocccal,typhoid,hepatitis vaccine taken on 23/1/22

GENERAL EXAMINATION

Patient was conscious, coherent and cooperative. Well oriented to time, place and person.

Pallor present

Icterus absent

Cyanosis, clubbing, lymphadenopathy, Pedal edema absent

Clinical images

Vitals

Temp: Afebrile

PR- 96 bpm

RR- 18/Min

Bp-110/70mm of hg

Spo2-99%

BP- 110/70 mmHg

Height-144cm

Weight-36kg

SYSTAMIC EXAMINATION

CVS-s1 and s2 heard ,no murmurs

RS-bilateral air entry present,normal vesicular breath sounds are heard

CNS-no neurological deficit

P/A-soft and non tender

PROVISIONAL DIAGNOSIS

Sickle cell anemia with vaso occlusion crisis

INVESTIGATIONS

Hemoglobin-8gm/dl

TLC-22,900

PCV-23.1(normal-36 to 46)

BLOOD group -O positive

Total bilirubin-20.15

Direct bilirubin-14.13

SGOT-170

SGPT-180

ALP-560

CRP-negative

Serology -negative

LDH-

blood urea-20mg/dl

Creatinine-0.4

Electrtrolytes-sodiun- 136 mEq/l

Pottasium-4.5 mEq/l

Chloride-101mEq/l

Calcium 1.02mmol/l

Peripheral smear-

Anisopoikilocytosis with predominant Sickle cell,normocytes,few microcytes

WBC count increased

PLATELET count increased

X-RAY

TREATMENT-

IVF NS and DNS

Inj PAN 40 mg/day

Inj OPTINUERON

inj DICLO

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SHORT CASE

A 47 year old female . Homemaker by occupation. resident of nalgonda.came to the opd with a cheif complaint of pedal edema since 15day

Shortness of breath since 15 days

cough since13 days

fever since 3 days

History of presenting illness

patient was apparently asymptomatic

15 days back she developed pedal edema which was insidious in onset initially edema is seen till ankle which is pitting type and Then gradually progressed to knee .

15 days back then she developed SOB which was insidious onset a from last 12 days(grade 2 to grade 3 sob) and relived on rest for which she went to hospital and her hemoglobin levels found 3% and was advised for blood transfusion .since 4 days sob has reduced to grade 2

she developed cough since 12 days which productive in nature, yellowish white sputum no blood stain,non foul smelling

fever since 3days associated with chills and rigor

no history of weigh loss

no history of malaise

she noticed left side facial puffyness after 2 hr it reduced spontaneously

no abdominal distention

NoPalpitations

No Paresthesia in hand

No Loss of taste

Past History

from last 1 year there is pedal edema which is on and off

no history of diabetes, asthama,Hypertension, TB,thyroid and Epilepsy

Menstrual History

she attained menarchy at the age of

earlier she used to have regular 30 days Menstrual cycle with 3 days flow ,no clots

from 22march,2022 she is having regular 20 days cycle ,heavy Menstrual bleeding for 5 days for which she went to hospital and was diagnosed by fibroid uterus and was advised for hysterotomy because of her low hb level surgery was not done.she under went blood transfusion later her Hb was found to be 8gm% which was not adequate for surgery

Since last 6 months spotting is seen for every 15 to 20 days of cycle

Personal history

Normal appatite

Mixed diet

Adequate sleep

Regular Bowel and Bladder movement

No addictions

No allergies

Daily routine-she wake up at 5 am does daily work(sweeping,washing cloths)then she will have a glass of milk at 12 pm she will have rice ,dal and curry then she will have sleep for a hour

Watch TV for 1 to 2 hr then at 9pm she will have dinner(chapati and curry)

Sleep at 10 pm

diet history

1 glass milk-129 cal,8g

Lunch-rice 2 cups-414 cal,6.6g

Curry 1 cup -80cal,6g

Dal 1 cup -89cal,7g

Milk 1 glass -129 cal,6.6 g

Dinner-chapatti2 and half-172 cal,8g

Curry-80 cal,6

Total -59.6 g and 1091 cal

She is deficit of 1509 cal