A case of pyrexia under evaluation with ?drug induced rash

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A 66 year old lady came to casualty with complaints of fever on and off since 1 week, generalized body swelling since 1 week, decreased urine output since yesterday,SOB continuous since 2 days

She's a homemaker and she underwent a tubectomy 30 years ago and she was diagnosed with hypertension 6 years ago n was started on antihypertensive medications which she uses regularly since 5 years.she was apparently asymptomatic 1 week ago then she developed high grade intermittent fever and went to a RMP doctor for which she was treated with 2 pints NS on day 1 and again 3 pints NS on day 3 after which patient developed generalised body swelling and rashes all over the body which was erythematous macule with no specific pattern and again yesterday night and then she developed SOB since 2 days which was continuous in nature and present at rest.she doesn't have any similar complaints in the past.she complaints of decreased micturition since yesterday.there's no significant family history.

On examination patient is conscious, coherent and cooperative.

Patient has no pallor, icterus,cyanosis, clubbing,edema,lymphadenopathy

Vitals:

Temp-98.4 F

PR-88 BPM

RR-24 cpm

BP-140/80 mm Hg

Spo2-99% 

GRBS-205 mg/dl

Systemic examination:

CVS- S1S2+, no murmurs heard

RS-NVBS+, BAE+

P/A- soft,NT

CNS-NFD

Provisional diagnosis:

PYREXIA UNDER EVALUATION WITH ?DRUG INDUCED RASH 

INVESTIGATONS:

Haemogram:

Hb-11 gm/dl

TLC-21,700

PLT-70,000

LFT:

Tb-3.69

Db-2.30

AST-30

ALT-38

ALP-513

TP-5.6

ALB-2.28

RFT:

Urea-67

Creatinine-3.8

Uric acid-7.3

Ca-10

Phosphate-2.0

Na+-135

K+ - 3.9

Cl- -98

Urinary electrolytes:

Spot Na-211

Pottasium- 10.5

Chloride-240

ECG:

USG:

-Raised echogenicity of b/l kidneys.correlate with RFT.

-altered echogenicity of liver.correlate with LFT

 XRAY:

ABG:

TREATMENT GIVEN:

1) INJ.LASIX 40 MG/IV/STAT

2)INJ.AVIL 1 AMP/IV/STAT

3)INJ.NEOMOL 1GM/IV/SOS IF TEMP >102 F

4)T.PCM 650 PO/TID

5)INJ.PIPTAZ 2.25 GM/IV/TID AFTER TEST DOSE WITH 4.5 GM/IV/STAT

6)OINT.LIQUID PARAFFIN FOR L/A BD

7)IVF NS @UO+75 ML/HR