A CASE OF VIRAL PYREXIA WITH ORAL CANDIDIASIS AND CERVICAL LYMPHADENOPATHY
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A 90 year old female resident of Nalgonda came to op with complaints of fever since 1 day, swelling of tongue and pain during swallowing since today afternoon.she also complaints of generalized weakness since morning.
She had h/o fever 4 months ago associated with redness of tongue and nausea which subsided on medication and later has h/o fall and sustained injury to right femur after which implant was placed.
No h/o rash,SOB,Cough
No h/o lip swelling
No h/o outside, allergies and food exposure
No h/o DM, HTN,TB, CVA, CAD,Asthma, Epilepsy.
Patient has normal appetite, takes mixed diet, regular bowel and bladder movements and no addictions
On Examination patient is conscious, coherent, cooperative.
No pallor, icterus, cyanosis, clubbing, lymphadenopathy,edema.
Vitals:
Temp-99 degrees F
PR-72 Bpm
RR-19 Cpm
BP-70/40 mm Hg on admission
Spo2:98% at room air
CVS-S1S2+
RS-bilateral air entry+,clear
P/A: soft,non tender,bowel sounds heard
CNS:NFD
B/L Sub mandibular lymph nodes+
Right eye-pupil constricted,not rracting
Left eye- post cataract
Uvula-centre
Gag reflex+
Provisional diagnosis:
? Viral pyrexia with ?oral hairy leucoplakia/?oral candidiasis
INVESTIGATIONS:
CBP:
HB-10.6
TLC-11,000
PTC-2.34 Lakhs
CUE:
Sugar:++
Albumin:nil
M.P strip test-negative
Absolute Eosinophil count-220 cells/cumm
Rapid Dengue-negative
Serology-negative
RFT:
urea-40
Creatinine-1.5
Na-142
K-2.9
Cl-96
LFT:
TB-1.05
DB-0.19
AST-19
ALT-37
ALP-216
TP-6.9
Albumin-3.2
A/G-0.89
ENT REFERRAL:
TREATMENT:
1)IVF 2NS,2RL,2 DNS @75 ML/HR
2)T.PCM 650 MG PO/TID
3)T.PAN 40 MG PO/OD
4)T.ZINCOVIT PO/OD
5)INJ.AUGMENTIN 1.2 GM IV/BD
6) TEMPERATURE CHARTING 4TH HOURLY
7)GRBS 8TH HOURLY
8) MONITOR VITALS AND INFORM SOS
11/11/21:
S:fever, swelling of the tongue and pain
O:on examination patient is conscious, coherent, cooperative
Vitals:
BP-140/90 mm hg
PR-80bpm
RR-18cpm
TEMP-99.7 f
A: viral pyrexia
Oral candidiasis
?sub mandibular infection/? Ludwig's Angina
Cervical lymphadenopathy
P:
Treatment:
1)INJ.AUGMENTIN 1.2 GM/IV/BD
2)T.PAN 40 PO/OD
3)T.PCM 650 PO/SOS
4)INJ.METROGYL 500MG IV/TID
5)T.FLUCONAZOLE 100 MG PO/OD
6)T.ALLEGRA 120MG PO/H/S
7)INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
8) CHLORHEXIDINE MOUTH WASH
9) IVF-2 NS,2 RL @100ML/HR
10) GRBS 8TH HOURLY
11)BP,PR,SPO2/TEMP 4TH HOURLY
12/11/21:
S:fever reduced, swelling of the tongue and pain reduced
O:on examination patient is conscious, coherent, cooperative
Vitals:
BP-150/90 mm hg
PR-86 bpm
RR-18cpm
TEMP-98.4 f
A: viral pyrexia
Oral candidiasis
?sub mandibular infection/? Ludwig's Angina
Cervical lymphadenopathy
P:
Treatment:
1)INJ.AUGMENTIN 1.2 GM/IV/BD
2)T.PAN 40 PO/OD
3)T.PCM 650 PO/SOS
4)INJ.METROGYL 500MG IV/TID
5)T.FLUCONAZOLE 100 MG PO/OD
6)T.ALLEGRA 120MG PO/H/S
7)INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
8) CHLORHEXIDINE MOUTH WASH
9) IVF-2 NS,2 RL @100ML/HR
10) GRBS 8TH HOURLY
11)BP,PR,SPO2/TEMP 4TH HOURLY
13/11/21:
S:swelling of the tongue and pain reduced
O:on examination patient is conscious, coherent, cooperative
Vitals:
BP-130/70 mm hg
PR-82 bpm
RR-18cpm
TEMP-98.4 f
Oral examination:
floor oF the mouth-white grey,pus discharge+ on the floor of tongue, bleeding point+ on tip of the tongue and floor
CVS:S1S2+;Pansystolic murmur+
RS:BAE+,right mild IAA crepts+
P/A: soft,non tender,bowel sounds+
A: viral pyrexia
Oral candidiasis with cervical lymphadenopathy
P:
Treatment:
1)INJ.AUGMENTIN 1.2 GM/IV/BD
2)T.PAN 40 PO/OD
3)T.PCM 650 PO/SOS
4)INJ.METROGYL 500MG IV/TID
5)T.FLUCONAZOLE 100 MG PO/OD
6)T.ALLEGRA 120MG PO/H/S
7) CHLORHEXIDINE MOUTH WASH
8) IVF-2 NS,2 RL @100ML/HR
9) GRBS 8TH HOURLY
10)BP,PR,SPO2/TEMP 4TH HOURLY
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