CASE PRESENTATION

Presenter: Dr Rama Bhupal Reddy

Moderator: Dr Sasidhar
 A 60 years old female patient came with c/o
Fever since 1 week
SOB since 4 days.
She developed fever with loose stools and vomitings 1
week back. Loose stools and vomiting subsided after
2 days but fever persist. They went to Arogya
hospital. There she was diagnosed to be
hypothyroid.
After 4 days from there they shifted the patient to
Citizens hospital for further management.
Fever high grade, not associated with chills , subsided
by taking medication. No h/o rash.
• No H/O sore throat, cold and cough.
• No H/O Dysuria
• No H/O chest pain, Palpitations.
• Patient is a known case of HTN.
• No other comorbidities.
• O/E:
PR: 130/min
BP: 80/42 mmHg
SPO2: 90 on O2 6lit/min
CVS: S1S2+, No murmurs
RS: BAE+, No added sounds
P/A: Soft
CNS: Drowsy , arousable
No focal neurological deficits
• Patient was shifted to Radiology department for
MRI Brain. Patient got arrested during MRI brain. 1
cycle of CPR done, she was intubated and she was
revived. She was shifted to MICU.
O/E:
• PR:138/min
• BP:92/58 mmHg on Inj Noradrenaline 4 ml/min
• Spo2: 98
• CVS: S1S2+
• RS:BAE+
• P/A: Soft
• CNS:E3VTM5
• Mechanical Ventilation started.
• On investigation dengue IgM came positive.
pancytopenia present.
24/05/2022 (Day 3):
She was haemodynamically stable.
1 PRBC Transfusion given.
She was extubated.
She was conscious, moving all extremities but
unresponsive to verbal stimuli. CT brain was
done.
26/05/2022(Day5):
She became drowsy.
ABG-Respiratory acidosis
She was intubated.
Bone Marrow aspiration done.
EEG: Diffuse encephalopathy
27/05/2022 (Day6):
She was extubated
28/05/2022 (Day7):
She was intubated in v/o poor GCS and hypoxia.
Tracheostomy was done in the evening.
Bronchoscopy was done.
29/05/2022 (Day8):
Antiach – Receptor Antibodies came positive.
Tab. Pyridostigmine 30 mg P/RT TID started.
Blood and urine culture – sterile
BAL for Biofire penumonia panel : Acinetobacter
01/06/2022 (Day 11):
Repetitive nerve stimulation test: negative
Endocrinologist opinion was taken for sluggish
responsiveness.
Tab.Thyronorm dose was increased to 150
micrograms/day
06/06/2022 (Day 16):
Patient was decannulated.
After 1 hr she became tachyapnoeic and
desaturated. So again tracheostomy tube placed.
 08/06/2022 (Day 18):
• Nasal endoscopy: glottis and subglottic edema.
Granulomatous tissue at tracheastomy site and
subglottis level.
• Advised continuation of tracheostomy tube for 2
months,regular suctioning and tracheostomy tube
Care.
• Persistent hypokalemia was present during course of
the hospital.
• Fractional excretion of potassium was 40.
09/06/2022 (Day19):
• She was discharged .