25yr Female with SOB and fever

 

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PRESENTING COMPLAINTS:

Shortness of breath since 1week.

Fever since 10days.

Generalised Edema since 2months .

HISTORY OF PRESENTING ILLNESS:

Patient (G2P1L1) was apparently asymptomatic 2months back then she developed generalised edema for which she went to local RMP where she was diagnosed as  Gestational Hypertension and started on medication. 1week later she developed seizures 2 episodes - Tongue bite and loss of consciousness present. She went to Yashoda hospital and MRI was done which showed PRES (Posterior Reversible Encephalopathy Syndrome) 2D Echo showed global hypokinesia. LV Dysfunction with 45%Ejection fraction

On 10/10/2022 (30 weeks of gestation) Emergency LSCS was done in view of fetal distress (cord around the neck) 960 gm female child.. In OT she had one episode of seizure for which she was intubated, antihypertensive, anti epileptics, laxics, blood transfusion done. One week later she was discharged as LAMA. She went to hospital in Nalgonda on 16/10/2022 when she had pedal edema where they found out deranged LFT and RFT, Dialysis was advised, her haemoglobin was 7gm/dl so blood transfusion was given. She went to another hospital with complaint of pedal edema, oliguria, facial puffiness - 3sessions of hemodialysis done and 2 blood transfusion.

Later she developed Shortness of breath grade 2 insidious in onset aggravated on lying down.

 Fever high grade not associated with chills and rigors. Associated with Burning micturation and Hemoptysis. 

Complaint of headache during pregnancy.

HISTORY OF PAST ILLNESS:

Not K/C/O Diabetes, Thyroid, Tb , epilepsy.

No previous surgeries.

3 Blood transfusion sessions.

Previous Pregnancy - Conceived spontaneous. All three trimesters are uneventful. Normal full term vaginal delivery Of healthy Baby Girl (current age 4 years).

PERSONAL HISTORY:

Diet -mixed

Appetite -Normal

Sleep- Adequate 

Bowel movement -normal

Bladder -Burning micturition

No addictions and allergies.

FAMILY HISTORY: 

Patient’s elder sister died due to seizures 3yrs ago.

GENERAL EXAMINATION:

Patient is conscious, coherent and cooperative, well oriented to time place and person.

Moderately built and nourished.

Pallor -present

Bilateral pedal edema (pitting type)

No Icterus, Clubbing, cyanosis, lymphadenopathy

Vitals:

Temperature charting-

BP -120/80 mmHg

Pulse rate -88bpm

Respiratory rate -18cpm

SYSTEMIC EXAMINATION:

Respiratory system:

Shape of chest -elliptical, 

Trachea -central in position 

Movement of chest- B/L equal 

No scars and sinuses

NVBS+

CVS:

S1,S2 heard.

No murmurs.

JVP elevated.

P/A:

Soft, No organomegaly.

C Section scar present in lower abdomen.

Tenderness in left iliac fossa.

Bowel sounds +

CNS:

Higher mental functions -intact

Well oriented to time, place and person.

No Focal Neurological Deficit.

Investigations:

Anisopoikilocytes, schistocytes, bite cells

    

PROVISIONAL DIAGNOSIS:

Renal AKI secondary to Autoimmune disorder ?APLA 

MODS with DIC (non infective >infective)

PRES (Posterior Reversible Encephalopathy Syndrome) 

HELLP Syndrome ( Hemolysis, Elevated Liver enzymes, Low  Platelets)

TREATMENT:

INJ. LASIX 80mg—X—40mg IV BD

INJ. MEROPENEM IV OD

INJ. ZOFER IV TID

T. NICARDIA RETARD 20mg PO TID

T. MET XL 50mg PO BD

T.LEVIPIL 500mg PO BD

T. ECOSPRIN AV 75mg PO OD

T. HYDRALAZINE 12.5mg PO BD

Vitals monitoring 2hrly

Temperature charting 2hrly