46-year-old male with fever, abdominal distension and dark coloured stools

A 46 year old male patient presenting with c/o :

• Fever since 6 days.

• Dark coloured stools since 6 days

• Yellowish discolouration of sclera and urine.

• Abdominal distention since 3 days 

 History of presenting illness :

Patient was apparently asymptomatic 6 days back following which he developed Fever which was associated with chills and cold and aggravated at night.

They went to a local RMP and the fever subsided with injections (according to the attenders). But then 3 days later the fever recurred and they went to a local hospital again where investigations were sent and performed and the patient was found to be positive for dengue antigen.

His platelet count was less and patient was administered with 1 unit of SDP on 6th Dec.

On 7th his platelet count was 23,000 and another unit of SDP was transfused after which his platelet count raised to 30,000.

• patient developed melena 2 days following fever.

• 3 days after fever started the patient developed abdominal distention which was insidious in onset and not progressing.

• 5 days following fever the patient noticed blood in urine, associated with clots.(foleys inserted 4 days back and blood noticed in urobag.)

• Patient attenders noticed hyperpigmentation of skin over face.

Past history :

No h/o DM, HTN, TB, BA, EPILEPSY, CVD.

Personal history :

Diet- mixed, Appetite and Sleep - Decreased, Bowel and bladder movements - Regular. 

Family history :

Not significant 

General examination:

Patient consious, coherent, cooperative.

Signs of icterus in sclera and eyes

No signs of clubbing, lymphadenopathy, edema

Vitals: 

Temp: 98.6 F

Pr: 84 bpm

Rr: 20 cpm

Grbs: 115 mg/dl

Spo2: 98%

Systematic examination:

CVS: S1 and S2 heard

RS: BAE + 

P/A: soft , non tender.

CNS: NAD

Clinical images :

                Abdominal distension 

Mild Icterus - Present 

                 Dark colored stools

Provisional diagnosis:

? Dengue hepatitis (NS Antigen +ve)

Plan of treatment:

1. Ivf NS/RL/DNS continuous at 100ml/hr

2. Inj. PAN 40mg IV BD 

3. inj. ZOFER 4mg IV/SOS

4. Inj. NEOMOL 1gm IV/SOS

5. Tab. PCM 650 mg PO/ SOS

6. Inj. OPTINEURON 1 AMP in 100ml NS IV/OD

7. W/F bleeding manifestations 

8. BP/PR/TEMP monitoring 4th hourly 

9. GRBS charting 12th hourly.

8/12/21 and 9/12/21