BMJ Elective Case Log

Disclaimer:- This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here August 2017 after collecting informed patient consent (form downloadable Click Here) .   A 40-year-old lady presented with the history of significant head injury 5 years back where she was comatose  for 12 days and regained consciousness with left sided weakness from which she recovered and started doing normal household work. From last 2 months attendants started noticing that her voice was changing, slurring gradualy and they also told that she was coughing each time she tried to drink water or milk. She was feeling a sense of imbalance.  On examination, respiratory rate was 27 per minute, regular, no pallor, cyanosis, clubbing. Her higher mental function was normal . She has had dysarthria? scanning speech, and swaying to right side, however it is not clear if it was due to her weakness. All cranial nerves normal except 10 and ...

Pregnancy that changed her life    A 28 Y old female resident of durgapur came to hospital on 22 nd may 2017 with the chief complaint of altered sensorium, slurring of speech, drowsiness and since 1day. Patient was apparently alright 1 year back around April 2016, it all started after caesarean section of pregnancy where she had developed bleeding, after 1 hour she developed flushes and anasarca. At that time she passed only 650 ml of urine. After transferring to a higher centre where she was diagnosed as AKI (Acute Kidney Injury). She was given haemodialysis for 1.5 months. During this she developed sepsis for which she was given meropenem injection. In the month of June she was given 1 unit of blood as her RBC were decreased.During July and august she developed DVT in the femoral vein that had a hemodialysis catheter inserted in it. After that she developed restlessness, slurring of speech for which she was admitted to hospital where she has undergone 3 ca...

A 58-year-old lady presented with complaints of vomiting with fever for 4 days and pain abdomen for 2 days prior to admission. Diabetic Ketoacidosis. Her past medical history was significant for hypothyroidism for 8 years, hypertension for 10 years, type diabetes mellitus for 17 years (she says her diabetes started after an abdominal tumor removal- details of which is not available) .  On general examination, she was conscious, alert and oriented. Her blood pressure was 120/80 mmHg, Pulse was 120/min, temperature was 99.5 degree F. Respiratory system examination showed normal vasicular breath sounds. On cardiac examination, S1 and S2 was audible with no murmur. Abdomen was soft and nontender. CNS examination found no neurological deficits. Her Urine report was positive for ketone body (++). Patient was diagnosed to have diabeteic ketoacidosis. {Her discharge summary and advice on discharge documents are attached below]: Despite adequate fluid management her glucose l...

A 57 year old woman with diabetes and uncontrolled blood sugars had an MDR urinary tract infection and was sensitive only to colistin and tigecycline (figure 1-3). Her weight is around 60 KG. Her eGFR was 42 mL/min/1.73 m2.   1 2 3 Based on the Urine C/S report, one shot of colistin 9 million units was given and as the patient couldn't afford any further therapy and just after one shot of colistin subjectively she was much better, so collistin was stopped.  In this case the patient had a short window of opportunity to benefit from just a single shot of colistin which was serendipity as at that point of time we didn't know that she wouldn't be able to afford the subsequent doses. Once she said that her symptoms had reduced dramatically with that one shot of colistin we felt that this was our window of opportunity as we needed to check out what was happening to the MDR klebsiella inside her and repeat urine culture sensitivity now showing that ...

A 35-year-old female presented to our OPD complaining of cough for 1 month and low-grade fever for 1 year. She is on treatment for Lupus. She has a history of fibroid for 5 years and purpura for 1.5-2 years. His chest radiograph and HRCT is attached below: Right upper lobe abscess on follow up with CxR pa today. These eruptions are noted over the skin of back and abdomen in this patient who recently discharged from the hospital. This patient now appeared to have developed these pustules again on the same area where the vesicular lesions had first appeared. what are these new lesions?  (updated on 24/08/2017) Conversation around this case: Rakesh Biswas Thanks Vivek . Amit , DrDeepanjan will be looking forward to your and others inputs on this current patient Rajendra Takhar Looking at the under treatment status for lupus and two of the cardinal symptoms of tuberculosis with supportive evidence from radiology, I would definitel...

A patient with PUO admitted with us for 19 days and yet no respite in his fever. [1] Recently detected diabetes, BPH, initially grew E Coli in small amount and later cultures sterile. The CT has been reported as bilateral centrilobular nodules of infective origin by our radiology department. [2] The LFT above is suggestive of dissemination although the transaminitis appears to be receding. [3,4]  His Mantoux test was negative and this completes most of his work up here. A bone marrow is planned tomorrow for cultures,  mtb,  parasites and other infiltrates. Figure 1 Figure 2 Figure 3 Figure 4 

A-55-year old female has presented to our hospital with a generalized lymphadenopathy  and her complete blood count showing very low WBC count (2100 cells/microL) and her differential count of lymphocytes count is showing 45% and neutrophil count is 50% and hemoglobin is 5.9 gm%, MCV 90.1, MCH 27.8, MCHC 9.9. Previously, the patient had a differential count for lymphocyte 56% with the around same low Total WBC count.  We are suspicious of the case might of CLL or NHL. We have tried to know the absolute lymphocyte count (ALC) in an attempt to see if the first criteria in diagnosing CLL ( Absolute B lymphocyte count in the peripheral blood ≥5000/microL [5 x 109/L], with a preponderant population of morphologically mature-appearing small lymphocytes.) is met. Even though the total number of WBC is less than the 5000, we tried to calculate ALC with the following formula: ALC (cells/microL)  =  WBC (cells/microL)  x  percent lymphocytes  ÷  1...