A 14 YEAR OLD MALE WITH ATT INDUCED HEPATITIS

This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based input.

CHEIF COMPLIAN:
Patient complaints of fever since 5 days and vomitings since 3days ( 5-6episodes).

HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic 1 month  back then he developed fever, which is high grade fever, not relieved on taking medication.
H/O 5-6 episodes of vomiting , which is bilious, non projectile
History of night sweatings
K/c/o gangrene on finger tips
No history of loss of appetite
No history of short ness of breath 

PAST HISTORY:
Not a known case of, hypertension, diabetes, epilepsy, asthma.
K/c/o of tuberculosis since 15days
K/ c/o SLE since 2months.
H/O injury to index finger and surgery done to finger at 1 year of age.
Cervical biopsy has been done.

FAMILY HISTORY:
 Familial History of tuberculosis.

PERSONAL HISTORY:
Diet- mixed
Appetite- normal 
Bowel and bladder movements- Regular
Allergies- No
Addictions- No

GENERAL EXAMINATION:
Pt is conscious, coherent and cooperative and well oriented to time,place and person
At the time of presentation hand  are cold compared to forearm.
No pallor,icterus,cyanosis clubbing,edema, malnutrition. 

VITALS-
TEMP- febrile
BP- 80/ 60 mmHg 
Pulse rate-86bpm 
RR- 18cpm

SYSTEMIC EXAMINATION:
ABDOMINAL EXAMINATION:

INSPECTION:
Shape - scaphoid
Flanks - full
Umbilicus- inverted 
Skin - No visible scars
No visible pulsations

PALPATION: 
No palpable mass
No rise in temperature.

AUSCULTATION: 
Bowel sounds heard.

PERCUSSION: 
Tympanic note is heard

CVS EXAMINATION :
No visible pulsations, scars, engorged veins.
S1 S2 heard . No murmurs.

RESPIRATORY SYSTEM:
Bilateral Airway Entry - positive
 
CNS EXAMINATION  
Patient is conscious
Speech -normal
INVESTIGATIONS: 
Blood test
Chest x ray
Mantoux test 
Bacteriological investigation: 
Sputum, urine, bone marrow - culture of afb
LFT
No abnormality detected.

PROVISIONAL DIAGNOSIS
Extrapulmonary tuberculosis
SLE,
HEPATITIS 

FINAL DIAGNOSIS
ATT INDUCED HEPATITIS.

TREATMENT:
STOP ANTI TUBERCULOSIS DRUGS
IV FLUIDS
INJ. NEOMOL1gm iv stat 
INJ.ZOFER 4 gms iv stat 

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