Noon

report
24/6/2011

 Admission 16/6/54
56
. .

CC : 1
.

PI : 6 .
. admit 3
melioid <ter 1:1250
.
admit . 4-10
2553 melioid <ter 1: 160, H/C : NG
Dx. systemic infec<on ceGazidime 2 gm iv q
8 hrs. + doxycyclin <100> 1*2 pc * 5 day d/
c doxycyclin <100> 1*2 pc

 5 . .

ATB ceGazidime * 7 day
then Tienam ()
LN biopsy : lymph node hyperplasia , melioid
<ter : nega<ve Bactrim + doxycyclin

4 .

. Bactrim o
bactrim Augmen<n<1> 1*2pc

 3 . .


melioid <ter 1:160
admit
doxycyclin + Augmen<n
1 .

.
.
Imp : disseminated melioidosis

 . LN biopsy
reac<ve lymphhoid hyperplasia
skin biopsy presence of a lot of
neutrophils & some eosinophils,
consistent with acute inamma<on, no
evidence of granuloma
ATB cefotaxime + amikin +
clarithromycin
admit 10 d/c

 1 .



4-5 /

4-5


.

 PH : -
- sulfa
- 6
- 10
- 2
2
- contact TB

FH :

Physical examina<on

A late middle age man, good conscious, well co-opera<ve

V/S : BT 37 C , PR 80 bpm, RR 20 tpm,
BP 100/60 mmHg
HEENT : - Not pale, mild jaundice
- Submandibular LN size 1 cm both side
- mul<ple Lt CLN size vary 0.3 0.5 cm.
- Rt posterior CLN size 1 cm
all lymphnode are rm, movable and not tender
- no oral trush, no oral hairy leukoplakia

 Heart : - no ac<ve precordium, no heaving

- no thrill, PMI at 5th ICS in MCL
- normal S1S2, no murmur
Lungs : - normal BS, no adven<<ous sound
Abd : - at abdomen, no bulging

- normal bowel sound

- soG, not tender, no guarding

- liver & spleen : impalpable

- liver span 8 cm, splenic dullness -ve

 Ext : - Lt axillary LN size 3 cm

- Rt epitrocheal LN size 2 cm
- Rt groin node size 3 cm * 1 node


size 2 cm * 1 node



size 1 cm * 3 nodes
- Lt groin node size 2 cm
All lymphnode are rm, moveble and not
Tender
PR : yellowish mucous stool, no mass, no rectal shelf
Proctoscope : not seen pseudomembranous

 Skin : - generalized pustular

above erythematous papule &
plaque lesion at trunk & limbs
- erythematous papules
with central necrosis at Rt elbow

Problem list
Prolong fever
Generalized lymphadenopathy
Generalized pustular erythematous
skin
Acute diarrhea

Inves<ga<on
CBC
Hb

11.3

Hct

33.7

WBC

Platelet

16,330
<PMN with toxic granule 55 , L 12 ,
M 6, E 14, band PMN 13>
493,000

MCV

76.4

Blood chemistry
BUN

10.1

Crea<nine

0.8

Na

130

3.1

HCO3

23.8

Cl

96

Ca

8.4

PO4

3.2

Mg

1.4

LFT
cholesterol
TP
albumin
TB
DB
ALT
AST
ALP

144
6.4
2.8
0.6
0.2
20
15
112

CXR

Pus G/S : numerous PMN, no

organism
Melioid >ter : 1:40
CRP QT : 55.73
CRP QL : posi<ve

 H/C <9/5/54> : Rapidly Growing

Mycobacterium <RGM>
sensi%vity : amikin, erythromycin,
clarithromycin, ciprooxacin,
imipenem
Intermediate sense : cefoxi<n
Resistant : bactrim, tetracyclin,
doxycyclin, Ertapenem

Stool exam
consistency

loose

Pus cell

20-30

Occult blood

nega<ve

Conc. for parasite Not found

C.Dicile toxin A,B nega<ve


ID rapid growing NTM
Skin Sweets syndrome, AGEP