A 14 YEAR OLD MALE WITH ATT INDUCED HEPATITIS

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CHEIF COMPLIANT:

Patient complaint of fever since 5 days and vomitings since 3days ( 5-6episodes).

 HISTORY OF PRESENT ILLNESSES

Patient was apparently asymptomatic1 month  back then he developed 

Fever, which is high grade fever, not relieved on taking medication.

H/O 5-6 episodes of vomiting , which is bilious, non projectile

History of night sweatings

K/c/o gangrene on finger tips

No history of loss of appetite

No history of short ness of breath 

PAST HISTORY:

Not a known case of, hypertension, diabetes,, EPILEPSY, ASTHAMA.

K/c/o of tuberculosis since 15days

K/ c/o SLE since 2months.

H/O injury to index finger and surgery done to finger at 1 year of age.

 

Cervical biopsy has been done.

FAMILY HISTORY

 Familial History of tuberculosis.

Personal history:

Diet- mixed

Appetite- normal 

Bowel and bladder movements- Regular

 Allergies- No

Addictions- No

GENERAL EXAMINATION:

Pt is conscious, coherent and cooperative and well oriented to time,place and person

At the time of presentation hand  are cold compared to forearm.

No pallor,icterus,cyanosis clubbing,edema, malnutrition. 

VITALS-

TEMP- febrile

BP- 80/ 60

Pulse rate-86bpm

RR- 18cpm

SYSTEMIC EXAMINATION:

ABDOMINAL EXAMINATION:

Shape of abdomen scaphoid 

Umbilicus inverted , No abdominal distention,no visible pulsations,scars and swelling.

PALPATION

NO palpable mass

No rise in temperature

Auscultation: 

Bowel sounds  heard.

PERCUSSION: 

Tympanic nodes are heard

Cardio vascular examination:

  No visible pulsations, scars, engorged veins.

   S1 S2 heard . No murmurs.

Respiratory system : Shape of chest is elliptical, b/l symmetrical.

 Trachea is central. Expansion of chest is symmetrical

   Bilateral Airway Entry - positive

  Normal vesicular breath sounds

 

CNS EXAMINATION  

Patient is conscious

Speech -normal

INVESTIGATION 

Blood test

Chest x ray

Mantoux test 

Bacteriological investigation: 

Sputum, urine, bone marrow - culture of afb

LFT

No abnormality detected.

PROVISIONAL DIAGNOSIS

Extrapulmonary tuberculosis

SLE,

 HEPATITIS 

FINAL DIAGNOSIS

ATT INDUCED HEPATITIS.

TREATMENT:

STOP ANTI TUBERCULOSIS DRUGS

IV FLUIDS

INJ . NEOMOL1gm iv stat 

INJ.ZOFER 4 gms iv stat