A 14 YEAR OLD MALE WITH ATT INDUCED HEPATITIS

This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's 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 input.
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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