A 41 years old female came with fever, cough since 10 days

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Name : Lakshmi Manvitha Yechuri 

Roll.no : 169 

9th Semester 

A 41 years old female came with fever, cough since 10 days 

Chief complaints : 

•fever since 10- 15 days 

•Cough with expectoration since 10-15 days

•Loss of appetite since 10 days 

HOPI:

The patient was apparently asymptomatic 10 days ago , 

later she then developed low grade fever which is insidious in onset gradually in progression and continuous type  associated with chills during the night time.

She also complained of cough which is productive  type no aggrevating , relieved on medication,  sputum is white colour on admisssion . Now the cough is relieved. 

No H/o weight loss

No H/o night sweats, No H/o blood stained and bile stained sputum 

Past history :

No similar complaint in the past 

She has visited near by hospital 10 days back with complaints of pain and fever and cough so they have taken X-ray and CT Scan they told that she has fluid in her lungs. And referred her to our hospital 

Not a known case of DM, HTN, CAD, CVA, Epilepsy, Asthma 

Personal history 

Diet: Mixed 

Appetite: Decreased

Bowel and Bladder movements : Regular

Addictions: No addictions 

Allergy : no allergies 

Family history : non significant 

On Examination : 

General examination 

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

No Pallor , Icterus , Cyanosis , clubbing , lymphadenopathy, pedal edema 

VITALS 

Temp: 97 F

BP: 120/80 mm Hg

PR: 90 bpm

RR: 19 cpm

GRBS: 121 mg/dl

SpO2: 98 % @ RA

Systemic examination 

CVS-S1S2 +, No Murmurs 

P/A: Soft , Non tender , No hepatosplenomegaly  

CNS: Intact 

Respiratory System 

INSPECTION :

Symmetry of chest  : Symmetrical 

Position of Trachea : central

Decreased chest expansion on left side  

No visible dilated veins

PALPATION :

Non tender 

Trachea : midline

Dilated veins absent 

Apical impulse : seen on left 5th intercostal space 

Chest Expansion : decreased on left side 

Vocal fermitus : decreased in infraaxillary and infrascapular areas

PERCUSSION

Dull note on percussion on infrascapular and infra axillary areas

AUSCULTATION 

Breath sounds : Normal Vesicular Breath Sounds on right side 

Left side:  Left infrascapular and infra axillary- breath sounds reduced breath sounds 

Crepitus left infraaxillary infrascapular areas  heard 

Vocal resonance decreased on left infrascapular and infrascapular areas

INVESTIGATIONS 

Complete Blood Picture : 

Hemoglobin - 12.7 

TLC - 5,900 

Lymphocytes- 30 

Neutrophils - 60 

RBC - 4.49 

Platelets - 4.2 

Normocytic Normochromic

Erythrocyte sedimentation rate :- 

ESR - 90

Complete Urine examination:-

Albumin: Trace 

Sugar : Nil

pus cells : 2-4  

Epithelial cells : 2-3                    

2D ECHO 

EF: 58%  

Pleural Fluid 

T.C: 12,000 

D.C:  80%

Sugars - 97 ( 60- 90 ) 

Protein - 5.5 (0-2.5)

Serum albumin = 4.2 

Serum protein = 7.8 

Serum LDH = 145

Impression:- 

Features are suggestive of inflammatory smear

Clinical Images 

Provisional diagnosis: Left sided pleural effusion with Right sided upper lobe fibrosis( secondary to TB??? Under evaluation) 

Lights criteria :

Serum LDH : 145

Pleural fluid LDH : 707

Serum protein: 7.8

Pleural fluid protein: 5.5

1. Pleural fluid protein/serum protein = 0.70

(Greater than 0.6)

2. Pleural fluid LDH / serum LDH= 4.87

(Greater than 0.5)

3. Pleural fluid LDH > 2/3rd of normal upper limit of serum  = 707 > 306 

(460-2/3= 306 ) 

3/3

Hence exudative type 

TREATMENT 

Tab PCM 650 mg PO/SOS

Tab.PAN 40 mg PO/OD

Tab. ZINCOVIT PO/BD

Tab. LIMCEE PO/BD

Syp GRILLINCTUS 10 ml PO/TID