56 YEAR OLD MALE WITH GENERALISED LYMPHADENOPATHY

E-LOGS OF MEDICINE
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 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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