CASE

PRESENTATION
Almaarefa University
KSMC
Abdulhamid Sakr : 151120236
CHIEF COMPLAINT
 Mohammed
 A male patient of age 53 years, Syrian , K/C of DM 2 , RA ,occupation by work in Company,
resident in Riyadh, Married , presented with complaint of general body pain , weakness and
joints pain for 2 days .
H/O PRESENT ILLNES •
 Pain was moderate 6/10 , in shoulders and knees also in
hip , otherwise 4/10 body pain in general . sudden onset ,
radiating from joint to joint , stabbing in nature , increase
at night and no releasing .
CONT.….
 •Dizziness and vomiting for 2 days
 • Fever for 2 days along with headache and neck stiffness
 • No weight loss , night sweat .
 • Bowel and bladder habits were normal
PAST HISTORY
 • DM type 2 for 4 years , rheumatoid arthritis since 20 years.
 • No H/O HTN/ / TB/ EPILEPSY / Bronchial Asthma.
 • No H/o any surgery in the past.
 • No H/o cardiac problems.
PERSONAL HISTORY
 Built - moderate
 Diet-Mixed
 Appetite-loss
 Sleep- loss
 Bowel and Bladder – regular
 No addictions and smoking .
 No Significant family history.
 No known history of drug or food allergies.
 Medication : Metformin , oral steroid , hydroxychloroquine
REVIEW OF SYSTEMS
• Head and neck
• CNS
• RESP
• GIT
• GENITO-URINARY
• SKIN
• ENDOCRINE
• OTHERS

Unremarkable
GENERAL EXAMINATION
 • On examination patient is conscious, coherent, cooperative.
 • Moderately built and moderately nourished.
 • No -pallor .
 • No -icterus, no- clubbing, no- cyanosis, no lymphadenopathy, no- edema
 Vitals:
 • Temp = 38.8 c
 • HR -90 bpm, regular, rhythmic normovolemic.
 • BP-130/80 mmHg measured on Rt arm in supine position.
SYSTEMIC EXAMINATION
 • Respiratory : normal vesicular breath sounds in both
lungs . No findings .
 • Cardiovascular : S1S2M0 . Normal findings.
 HEENT examination : unremarkable
 Genitourinary : unremarkable
 Skin : by inspection ( subcutaneous nodules behind elbow )
 Kernig’s sign +
 Brudzinski’s sign +
CONT..
 Central Nervous System:
 • mental function: normal
 • Neck rigidity : present
 • Ophthalmoplegia : negative
 • Power : intact in all the four limbs
 • Tone : intact in all the four limbs
 • Deep tendon reflexes : intact in all four limbs
EXAMINATION OF ABDOMEN
 INSPECTION
 • Abdomen is not distended. umbilicus central in position
 • No sinuses/scars.
 • All quadrants are equally moving with respiration
 PALPATION
 • No organomegaly, no mass per abdomen
 PERCUSSION
 • Tympanic note all over the abdomen
 AUSCULTATION
 • Bowel sounds heard
 LABS (HEM , BIOCHEMISTRY)
 WBC: 5360/mm3 LYM 1.40 PMN: 82%
 • ESR: 105 mm•
 G-Stain : Bacteria +++

Malaria parasite: not seen

 • B24-negative
 CONT..
Glucose fasting 13.47 mmol/L High
Sodium 129 mmol/L low

Thyroid FT :
FT3 LOW
CSF FLUID ANALYSIS
Glucose (CSF) 12.84 High

Protein CSF 58 High

 RF Rheumatoid F = +++
 Anti CCP = +
IMAGINES
 CHEST XRAY PA VIEW : Clear chest


 ECG : Unremarkable.
Conclusion : Unremarkable CT of the brain
DIFFERENTIAL DIAGNOSIS
 Bacterial Meningitis
 Aseptic Meningitis
 Viral Meningitis
 Parasitic Meningitis
 Fungal Meningitis
 Tuberculous Meningitis
 Encephalitis
 COMPLICATIONS of RA
DIAGNOSIS

• Bacterial Meningitis
MANAGEMENT IN FIRST
WEAK
• Vancomycin + ceftriaxone IV Treat for 7- days
• Control blood sugar by metformin + insulin
•Normal saline
• NSAIDS . IV
• RA : drugs Cont.. .
CONT.. SECOND WEAK
 oral antibiotic tab. Vancomycin + ceftriaxone 3 days
 analgesics given for 5 days
 RA and DM : drugs Cont..
 • Pt is discharged
 • 1st follow-up – 1 week, Improving
 • Next follow-up – 1 month, no complaint of pain, no evidence of recurrence
SUMMARY
 52 male patient K/C of DM and RA , present complain of General body pain and weakness
with fever , headache , neck stiffness for 2 days . Has diagnosed by CSF sample by bacterial
meningitis . Then he has treated with antibiotic with controlling to other factors ( Ne , glucose,
RA ).
THANK YOU