56 YEAR OLD MALE WITH GENERALISED LYMPHADENOPATHY

E-LOGS OF MEDICINE
"This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment"
 A 56 year old male, daily wage labourer came with c/o

Pain abdomen since 20 days
Multiple masses per abdomen since 1 week
Fever (high grade) associated with chills and rigorous since 1 week.
History of presenting illness :
Patient was apparently asymptomatic 5 months back, then he developed dry cough which was sudden in onset, gradually progressive. Later he had fever - high grade, associated with chills and rigor.
He went to the hospital for the above complaints - fever was relieved with medications no replased after stopping the medicines.
Patient observed loss of weight and loss of appetite and 2 months later on advice of a govt doctor he got tested for Kochs and HIV - report was positive and was started on ART and ATT.

He now came with c/o abdominal discomfort, pain in periumbilical region a/w multiple masses felt over abdomen with fever, chills and rigor.
No h/o burning micturition
No c/o cough or SOB.

Vitals :
Temp - Afebrile
PR - 88 bpm
BP - 110/80 mm Hg
RR - 18 cpm
GRBS : 106 mg/dl
General examination :
Patient is conscious, coherent and cooperative 
No pallor, Icterus, Cyanosis, Clubbing
Lymphadenopathy + (Multiple palpable lymphnodes in neck and per abdomen)

Systemic examination :
CVS : S1 S2 +
CNS : NAD
RS : BAE +, Clear
P/A : soft, Non tender. Multiple lymphnodes palpable
X RAY
ECG
COLOUR DOPPLER
CUE
BLOOD SUGAR
Abdomen (USG)

Surgery referral :
Provisional diagnosis :
Fever with generalised lymphadenopathy 
?TB ?LYMPHOMA with RVD
ART
TAR DOLO 650 MO PO TID 2 TAI DOLUTEGRAVIR  
LAMIVUDINE 
TENOFOVIR 
DISOPROXIL FUMERATE
ATT DRUGS
RIFAMPICIN-150MG
,ISONIAZID -75MG
PYRAZINAMIDE -40MG
ETHAMBUTOL-250MG
TAB SEPTRAN-DS
NEOMOL-1GM I/V(SOS)
 PAN OMG IV OD

ZOFER 4MG IV SOS

8TAB MVT PO OD

SYRUP ARISTOZYME PO 10ML TID

Advice at Discharge

1.TAB DOLO 650 MG PO TID FOR SDAYS

2 TAB DOLUTEGRAVIR LAMIVUDINE.TENOFOVIR DISOPROXIL FUMERATE 50MG+300MG-300MG/PO/OD

3TAB

RIFAMPICIN ISONIAZD PYRAZINAMIDE ETHAMBUTOLITOMG 75MG, 400MG 2 4 TAB SEPTRAN-DS 800/160MG POBOX

STAR PAN 40MG POD 
6 TAB MVT PO OD FOR DAYS
7 SYRUP ARISTOZYME PO 10ML TID

Follow Up

REVIEW IN GENERAL MEDICINE OPD AFTER 15 DAYS

 

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