Case Presentation

A 48 years old male with

Fever, Cough & Breathlessness
 Particulars of The Patient
Name Ovi
Age 48yr
Sex Male
Marital Status Married
Address Keshorita,Gazipur
Religion Islam
Occupation Government employee
Date of Admission 22.10.23
Date of Examination 23.10.23
Chief Complaints
● Fever for 1 month
● Cough for 1 month
● Breathlessness for 1 month
● Weight loss for 3 months
History of present illness

According to the statement of the patient he

was reasonably well 1 month back.Since
then,he had been suffering from low grade fever
with evening rise of temperature which is
associated with profuse night sweat.
He also complains of mild cough with
occasional slight expectoration of
History of present illness

mucoid sputum which persists throughout the

day and night.
Patient also complains of mild breathlessness
for 1 month which is not associated with exertion
or lying position, diurnal variation, dust or fumes
and cold weather.
History of present illness:

During last 3 months he lost 5 kg weight. There

is no history of joint pain or swelling, skin rash,
headache or vomiting. His bowel and bladder
habit is normal.
HISTORY OF PAST ILLNESS:

No history of DM, Hypertension, Bronchial asthma or

TB

No history of such type of illness before.

Immunization history:
The patient was not immunized as per EPI schedule but
received 3 doses of covid-19 vaccine .

FAMILY HISTORY:
• His wife and children are healthy and not suffering from TB or
such type of illness.
• His other family members are also healthy and enjoying sound
health.
PERSONAL HISTORY:
Occasional smoker( 7-8 Sticks/day) for last 25 years,
Non alcoholic.
SOCIOECONOMIC CONDITION:
He comes from lower middle class family.
Housing: Tin shade house.
Sanitation:1 sanitary latrine.
Water supply : Arsenic free tube well water
 General Examination

Appearance : Ill looking & emaciated

Body Built : Below average
Co-operation : Co-operative
Decubitus : On Choice
Anaemia : Absent
Jaundice : Absent
Cyanosis : Absent
 General Examination
(contd.)

Koilonychia : Absent
Leukonychia : Absent
Clubbing : Absent
Edema : Absent
Neck Veins : Not engorged
Lymph Nodes : Not enlarged
Thyroid Gland : Not enlarged
 General Examination
(contd.)

Bony Tenderness : Absent

Skin Condition : No pigmentation
Dehydration : Absent
Pulse : 88 beats/min, regular in rhythm
Blood Pressure : 110/80mmhg
Respiratory Rate : 18 breaths/min
Weight : 60kg (reduced 5 kg over 3 months)
Temperature : 99.2 ֯F
RESPIRATORY SYSTEM
On Inspection :

• Size and shape of the chest : Normal

• Chest movement restricted in right lower part of chest
& normal in other parts of the chest
RESPIRATORY SYSTEM
Palpation:

Trachea: Trachea centrally placed.

Apex beat: In left 5th intercostal space 9 cm from
mid line & normal in character
Chest expansion: Reduced in right lower part of chest &
normal in other parts.
Vocal fremitus : Diminished from right 8th to 9th
intercostal space along midclavicular line .
RESPIRATORY SYSTEM

Percussion:
Stony dull at above mentioned area & normal in other parts of the chest

Auscultation:
Breath sound diminished at above mentioned area & vesicular in other
parts of the chest.
No added sound
Vocal resonance: Diminished in above mentioned area & normal in other
parts of the chest
Alimentary System

•Inspection :
•Mouth and oral cavity : Normal

•Abdomen proper :Normal

• Palpation :
Liver, Spleen, Kidney : Not palpable
No intraabdominal lymphadenopathy or palpable lump

•Percussion : Tympanic

•Auscultation : Bowel sound present

•Testis : Normal
CARDIVASCULAR SYSTEM

•Pulse : 88 b/min
Regular, normal in volume & character, all the peripheral pulses are normal.
•BP : 110/80 mm of Hg
•JVP : Not raised
•Precordium :
Inspection : Normal
Palpation: Apex beat in left 5th intercostal space 9 cm from midline
Auscultation: S1&S2 audible in all auscultatory area. No added sound
SYSTEM

•Higher psychic function including speech: normal.

Fundoscopic exam: Normal
Cranial nerves: intact
•Motor system examination
Both upper and lower limbs
•No muscle wasting or fasciculation
•Bulk of the muscle : normal
Tone of the muscle: normal
Power of the muscle: G-5
Sensory examination
All modalities of sensation are intact in both upper and lower limbs
Cerebellar signs: Absent
Signs of meningeal irritation: Absent
Salient Features
Md. Ovi aged 48 years old married muslim smoker
normotensive non diabetic government employee
hailing from Keshorita,Gazipur got admitted into
STAMCH with low grade fever for 1 month which was
not associated with chills and rigor and subside with
sweating. He also complained of mild cough with
occasional slight expectoration of mucoid sputum for 1
month. Patient also complains of mild breathlessness
for 1 month which is not associated with diurnal
variation, dust or fumes and cold weather.
Salient Features
There is no history of orthopnea or paroxysmal nocturnal
dyspnea. During last 3 months he lost 5 kg weight. He
has no history of chest pain and haemoptysis. On query,
he had no history of contact with known TB patient or
traveling into hilly area, joint pain or swelling, skin rash,
headache or vomiting, alteration of bowel habit and
urinary problem. General examination reveals no
anaemia, jaundice, clubbing, edema, lymphadenopathy
and no feature of superior vena caval obstruction.
Salient Features

Examination of respiratory system reveals restricted

Chest movement in right lower part, Trachea: Central in
position. Apex beat: normal ,Vocal fremitus : Diminished
from anteriorly right 8th to 9th intercostal space to
downwards along midclavicular line. Percussion: stony
dull. Breath sound absent and vocal resonance
Diminished at above mentioned area.Other systems
reveal no appearent abnormalities.
What is the Provisional Diagnosis?
Provisional Diagnosis

Right Sided Pleural Effusion most

probably due to tuberculosis
Differential Diagnosis

● Malignant pleural effusion

● Parapneumonic pleural effusion
 Complete Blood Count
Date

Hb 14.0g/dl

ESR 89mm/hr

Total count of WBC 9.9k/l

Neutrophil 6.73k/l

Lymphocytes 2.38k/l

Total platelet count 202k/l

MCV 85.2fl

MCH 29.2pg

MCHC 34.3g/dl
CXR P/A View
CXR P/A View
Sputum For AFB and Gene Expert
Pleural fluid study :
Appearance : Straw
Biochemical :
Sugar : 85 mg/dl
Protein : 6.1 gm/dl
Cytological examination : Lymphocyte predominant
Microbiological examination
Gm stain : (-ve)
AFB : Not found
Malignant cell : Not found
Pleural fluid ADA : 64 U/L
Other investigations
Confirmatory Diagnosis

• Right Sided Tubercular Pleural Effusion

Treatment

● Tab. 4FDC
● 4+0+0------(26/10/2023 to
25/12/2023)
● Tab. 2FDC
● 4+0+0------(26/12/2023 to
25/04/2024)
THANK
YOU