22 year old male with millary tuberculosis with thrombocytopenia secondary to viral pyrexia

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is a case i have seen:

A 22 year male ,agricultural worker by occupation ,came from nidmanoor,came  with chief complaints of 

feve since 5 days 

chest tightness with sob since 2 days

generalised weakness since 3 days

pt was apparently asymptomatic 5 days back ,then he had fever,low grade fever,continuous and  associated with chills ,relieved with medication .

also complaining generalised weakness with dragging type of pain in lower limbs ,unable to walk and unable  to do his regular work.

c/o of chest tightness since 2 days associated with SOB ,sudden in onset ,grade  III,relieved at rest,aggravating on exertion

no c/o cold ,cough

Appetite decreased since 3 days

c/o significant wt loss ,approximately about 1.5-2kgs in 1 week

no c/o chest pain,palpitations,syncopal attacks

no c/o orthopnoea,PND

n c/o abdominal pain,abdominal distension,pedal edema

no c/o burning micturition,constipation,loose stools

went to local hospital for management and on investigating plt-25,000 only , TB-4.5,DB-2 .9,IB-1.9 Absolute eosinophilic count-426,sr creat-2.0, with outside HRCT-showing multiple nodular opacities: miliary TB

no c/o leeding manifestation.

he alcoholic from 3 years ,90ml of whiskey /day 

smoker since 3 years ,1 packet for 3 days 

significant family history ,father was diagnosed tb 10 years back ,taken medication for 6 months

General examination :

pt c/c/c 

vitals: Afebrile

            bp : 100/ 70 mmhg

             pr : 94 bpm 

             rr : 26 cpm

             spo2 : 96 % at room air

no pallor,icterus,cyanosis,clubbing,lymphadenopathy,pedal edema

systemic examination : 

CVS: s1 s2 heard

RS: 

p/A:soft,non tender,mild liver enlargement

CNS:intact

INVESTIGATION:

platelet count

DAY1:12000 cells/cc

DAY2:   6am:13000 cells/cc

              6 pm : 22000 cells/ cc

DAY3:8 am:30000 cells/cc

Ecg:

chest x ray:

ct chest:

ultrasound abdomine:

TREATMENT:

DAY1 :

1)ivf  1 ns

1 rl continuous infusion @75 ml / hr

2) inj PAN 40 mg iv/od 

3) TAB PCM 500 mg po/sos

4) inj Tramadol 50 g in 100 ml Ns /iv/sos

5)Tab udiliv 150 mg / BD 

DAY 2

1)ivf  1 ns

1 rl continuous infusion @75 ml / hr

2) inj PAN 40 mg iv/od 

3) TAB PCM 500 mg po/sos

4) inj Tramadol 50 g in 100 ml Ns /iv/sos

5)Tab udiliv 150 mg / BD 

DAY 3

1)ivf  1 ns

1 rl continuous infusion @75 ml / hr

2) inj PAN 40 mg iv/od 

3) TAB PCM 500 mg po/sos

4) inj Tramadol 50 g in 100 ml Ns /iv/sos

5)Tab udiliv 150 mg / BD 

DAY 4

1)ivf  1 ns

1 rl continuous infusion @75 ml / hr

2) inj PAN 40 mg iv/od 

3) TAB PCM 500 mg po/sos

4) inj Tramadol 50 g in 100 ml Ns /iv/sos

5)Tab udiliv 150 mg / BD 

DAY:5

1)ivf  1 ns

1 rl continuous infusion @75 ml / hr

2) inj PAN 40 mg iv/od 

3) TAB PCM 500 mg po/sos

4) inj Tramadol 50 g in 100 ml Ns /iv/sos

5)Tab udiliv 150 mg / BD