18 year old female patient with fever and vomiting
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History of present illness:
Patient was apparently asymptomatic 2 months back, then she developed fever that was releived on taking paracetamol. After one week ,fever subsided then she started having multiple joints pains in upper limb ( IP, MCP, Wrist, Elbow, Shoulder joint).It is pricking type of pain which disturb her daily activity. Pain is relieved on taking medication and developed again on stopping of medication . She also give complaints of oral ulcers. She had vomitings which was non bilious,non projectile , food as contents.
Past History:
No history of diabetes, hypertension,asthma, tuberculosis, Thyroid disorders.
Personal History:
Diet :mixed
Appetite :decreased since 3 months
Sleep :adequate
B&B: Regular
General Examination:
Patient is conscious, coherent, cooperative.
pallor is present.
No Icterus, cyanosis, clubbing, generalised lymphadenopathy, pedal edema. Rash is seen on the nose and cheeks.
Vitals:
Temp-afebrile
PR- 83bpm
RR-18/min
BP-110/60 mmhg
Systemic Examination:
CVS : S1 , S2 heard, no murmurs
RS :BAE + ,NVBS heard
P/A :soft , non tender ,no organomegaly ,no distension ,bowel sounds heard
CNS: no focal neurological deficits
Investigations:
Coombs test:positive
ANA test : Positive
ds DNA test : Positive
Treatment:
1) Injection methylprednisolone 1gm IV Stat
2) Tablet paracetamol 650mg QID
3) Tablet pantop 40mg OD
4) Tablet zofer 4mg BD
5) IV fluids ‐ NS, RL, DNS ‐ 75ml/hr
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