58M with PUO

  NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT. 

PAST HISTORY: Pt is a 58 yrs old male. Used to work as a farmer (he had to work lengthy hrs in the field and water) for 13-14 yrs but later changed his profession and became a homeopathy shop owner for 21 yrs. Had to sell everything because of financial constraints.

He used to live near a forest area and had no access to purified drinking water during childhood. Pt reported when he was a farmer, he had no fixed time for bathing or eating since had to work long hrs in the field. 

For the past 30-40 yrs he used to suffer from fever (100-101F) quite often which would go away on taking medications within a few days. He would be fine for 2-3 months then again fall ill with a fever. Had suffered from malaria and typhoid at least 20-25 times since childhood. Used to take Primaquine for malaria at that time. Last, suffered from malaria 15 yrs ago. 

For the past 15-20 yrs, after bathing with soap he c/o fever, body aches, and recently also a whole body burning sensation.

Around July 2006, he had to travel a lot between Kolkata and his hometown, to take care of his relative who was diagnosed with leukemia. He could not take proper meals timely and drink water. After returning home, he c/o fever with chills, myalgia, tiredness, headache, lightheadedness, oral dryness, and low yellow urine output. He got admitted to a local healthcare center, where he was diagnosed with malaria, typhoid, and severe dehydration. 

A few wks after getting discharged, he started c/o sudden severe squeezing chest pain which would later convert to a tearing sensation and lasted for 20-40 mins happening 1-2 times 2-3 days/wk. It would radiate to the left shoulder and the whole left arm, also c/o of numbness in lt arm, and SOB. Dr. found his BP to be high and since then taking medication. Angiogram was done and coronary artery blockage in 2 arteries was detected. Medicines and prescribed and recommended to repeat angiogram after 4-5 yrs, which detected a blockage in only one artery. He is still continuing the medications.

In 2007 Dec, c/o sudden severe pain, in and around penis, and testicles with reduced urine output. He used to take Diclofenac i.m for pain relief, last taken 5 yrs ago. Dr. diagnosed it to be prostatitis and prescribed Sepmax DS (Trimethoprim (folic acid inhibitors) and Sulfamethoxazole (sulfonamides)) and Urimax 0.4 (Tamsulosin) for 15 days. His pain reduced but Dr. suggested continuing it.

 A few wks later revisited Dr. w/c/o persistent high fever, low urine output, urinary hesitancy, and burning micturition. Diagnosed as UTI and E.coli isolated. With medications got some relief. Fever used to occur from time to time lasting for 3 wks each month with temperature around 100F, w/c/o reduced appetite(no wt loss), and malaise. On taking Calpol 650 fever was used to reduce. Many a time after fever used to occur within 5 days c/o reduced urine output and pain around testicles. As prescribed by Dr. on taking Amikacin sulfate 500 mg i.v bd for 5-10 days his pain would reduce. After UTI detection, his fever frequency and duration have increased quite a lot.

In 2017 Jun, while shaving he noticed thickened nasal vestibule with no pain. Dr after doing a biopsy diagnosed it to be nasal vestibular carcinoma. Sx and nasal reconstruction were done in 2018.

For the past 2-3 yrs, c/o SOB on exertion (sometimes after walking up, while pumping tube well, climbing stairs). Dr. diagnose it to be COPD. No treatment was done.

Pt denied DM.

CHIEF COMPLAINT AND Pt. REQ.: 

Chronic prostatitis for the past 15 yrs. For the past 5 yrs pain reduced but urine output is still low.

UTI for the past 15 yrs. Happens 4-5 times /yr.

Low-grade fever for the past 35-40 yrs. For the past 15 yrs, happens almost 3 wks per month. 

COPD for the past 2-3 yrs

Coronary artery blockage for the past 16 yrs

HTN for the past 16 yrs

PERSONAL HISTORY: 

Married

Currently not working

Father of 

Addiction- smoking cigarettes for 40 yrs, 10-15/day. Started at the age of 17-18 yrs due to peer pressure and curiosity.

FAMILY HISTORY: 

Father- BPH, HTN, COPD, death due to MI.

Mother- death due to sudden cardiac arrest at age of 35

Brother- aged 55 yrs. HTN,BPH, high cholesterol, triglycerides, uric acid

Elder sister- aged 70 yrs, COPD, HTN

CURRENT MEDICATION:

Morning:

1. Metoprolol ( Met xl 50.)

2.Amlodipine 5 ( Stamlo 5 ) 

3. Ecosprin 150 mg + Atorvastatin 20 mg.

4. Aciloc 300.

At night before dinner:

1.Clonotril 0.5mg ( Clonazapam )

2. Tryptomer 10mg.

3. Urimax D. (4 months) and Urimax F (4 months)

4. Becadexamine

PROVISIONAL DIAGNOSIS: Chr. prostatitis, PUO, UTI, HTN, CAD, COPD

REPORTS:

Blood report 13 Nov 22

TC 8200.

N 71 

L 23 

M 01 

E 05 

Hb% 14.2 

ESR 26 mm 

1st hour.

Urea 24.6 

Creatinine 0.93 

CRP 12 Positive