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
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