Case by Vinila Bhavani


   48 yr old male patient, resident of Chityala came to OPD with chief complaints of : 
  Oliguria since 3 days 
 Altered sensorium since 5 days
Fever since 10days 

HISTORY OF PRESENT ILLNESS : 
    Patient was admitted in hospital with decreased urinary output for which Foley catheter was placed for draining urine . He was asymptomatic an year back . He was diagnosed with prostatomegaly with right renal calculi.
   Patient had bilateral lower limb weakness associated with oliguria . 

PAST HISTORY :
H/o HIV since 10yrs
 No  H/O of diabetes , hypertension , epilepsy.
  
PERSONAL HISTORY:
     SLEEP - adequate 
     DIET - mixed 
     APPETITE - normal 
 He use to drink alcohol of 250 ml occasionally and is a regular smoker .
    THERE IS No RELEVANT FAMILY H/O .  general examination : 
   Patient is conscious but incoherent . 

VITALS 
Pallor - absent 
Icterus - absent 
Cyanosis - absent 
Clubbing- absent 
Oedema - absent 

SYSTEMIC EXAMINATION : 
 ABDOMEN 
 Shape - obese 
Bowel sounds present 
Liver and spleen not palpable .

CVS :
S1 S2 heard 

RESP 
Normal vesicular breath sounds and no dyspnea , trachea is central .

CNS: 
Incoherent 
Kenigs sign +be 
Neck stiffness 
REFLEXES : 
Left side 
Biceps 1+ , triceps 2+,supinator , knee reflex and ankle reflex absent .
Right side 
 Biceps+2,triceps+2, supinator+2, knee , ankle reflex absent .



INVESTIGATION : 
CSF analysis , cxray , MRI, RBS . 
 PROVISIONAL DIAGNOSIS: 
altered sensorium secondary to meningoencephalitis .






TREATMENT : 
Started with 
1. Inj thiamine 1 amp in 100ml NS IV/OD 
2.tab Ecosporin Av 75/40mgOD 
3.inj Pan 40mg 
4.inj Optineuron 1 amp in 100ml NS IV/OD

On 10/6/21
 Inj thiamine 100ml 
Inj Optineuron 10ml OD
Inj Pan 40mg 
Tab Ecosporin 75/40mg
Tab Ceftriaxone 2gm
     Patient was improved oriented to time place and person .
CSF analysis showed hypoglycorrhachia , raised protein in CSF.
So he was given Ceftriaxone . 
 
On 12/6/21 
 CSF analysis showed presence of Diptheroids , 40 percent lymphocytes . 
Antitubercular theraphy was about to be started as TB was considered one of the differential .




Treatment was continued and HRZE - isoniazid , rifampicin , pyrazinamide,ethambutol regimen 4 TAPO /OD .
TDL regimen 1TAB /OD given .

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