16 yr old male pt presented to medicine op with chief complaints of fever, generalized pain abdomen, vomiting and generalized weakness.

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This is a case of a 16 yr old male pt presented to medicine op on 26th October 2021 

with chief c/o fever since 4 days  

c/o generalized pain abdomen since 4 days c/o vomiting since 3 days 

c/o generalised weakness since 4 days

History Of Presenting Illness:

Pt was apparently asymptomatic 4 days back , then he developed a low grade fever, intermittent in nature, not a/w chills and rigors, which was relieved on taking medications. 

He also developed generalized pain abdomen since 4 days which was intermittent in nature and squeezing type of pain. 

He c/o generalised weakness since 4 days. 

He developed vomiting since 3 days numbering to 2 episodes(non bilious, non projectile), which aggrevated on food intake and relieved on medications and glucose IV. He developed maculopapular rashes on thorax since 2 days.

No H/o itching, burning micturition, hematuria, hematemesis. 

Not a k/c/o DM /htn / tb / asthma / epilepsy.   

Past History: 

H/o typhoid 2 yrs back which was relieved on medication. 

Personal history: 

Diet- mixed 

Sleep- adequate 

Appetite- reduced since 4 days 

Bowel and bladder movements- regular Addictions- none 

Family history: 

H/o DM in paternal side (uncles) 

No H/o Asthma, HTN 

 

General Examination: 

Pt. is Concious/Coherent/Cooperative 

 

Vitals 

PR: 64 bpm  

BP: 100/70 mmHg 

RR: 16 cpm  

Temp: Afebrile 

SPO2: 100% at room air 

  

O/E

No signs of pallor, icterus, cyanosis clubbing, edema, lymphadenopathy.

Systemic Examination: 

1. CVS - S1 S2 +. No murmurs 

2. RS- BAE+ , NVBS+, centrally positioned trachea 

3. P/A- scaphoid, soft, non tender 

4. CNS- 

Level of consciousness- Concious/Alert 

Speech: Normal 

Normal cranial nerves, motor system, sensory system Neck stiffness- absent

Normal Reflexes. Rt. Lt Biceps. + + Triceps. + + Supinator. + + Knee. + + Ankle. + + Plantar: flexor 

Cerebral Signs:Finger Nose and Heel Knee in coordination 

Normal Gait

Normal #Musculoskeletal system, Skin, ENT, Teeth and oral cavity, Head and neck examinations revealed normal results. 

 Provisional Diagnosis: Viral pyrexia secondary to Dengue 

 

Investigations: 

Blood for MP strip: Negative 

NS1 Antigen:Positive 

IgM: Positive 

Hemogram: 

Hb-14.3 

TLC-2700 

MCV-81.0 

MCH-26.9 

PCV-43.0 

PLC-60,000 

NORMOCYTIC NORMOCHROMIC

CUE: 

Albumin- nil 

Sugar- nil 

RBC Cast- nil 

Pus Cells- 2-4 

Epithelial cells- 2-3

LFT: 

TB- 0.71 

DB- 0.20 

SGOT- 213 

SGPT-126 

ALP-566 

Total Protein- 5.6 

Albumin- 2.8 

RFT: 

Blood Urea-13 

S. Creatinin- 0.7  

Na- 137 

K- 4.0 

Cl- 198 

ECG: Normal findings

Radiograph: AP view of chest X-Ray with no anomalies.

Ultrasonography:

Shows 

# Mild Ascites 

# Gall Bladder wall Oedema

THIS IS A CASE OF VIRAL PYREXIA WITH THROMBOCYTOPENIA SECONDARY TO DENGUE 

Treatment: 

1. IVF- NS & RL @75ml/hr 

2. Inj. PAN 40mg OD 

3. Inj. Opineuron 1 amp in 100 ml NS IV/ OD 4. Inj. ZOFER 4mg IV/BD 

5. BP, PR, SPO2 monitoring 4th hourly 

6. Strict I/O monitoring 

7. GRBS monitoring at 8am in the morning 

8. Inform SOS 

9. Inj. TAXIM 1g IV/BD 

10. TAb. Doxycycline 100g BD