14 year old girl with fever and swelling of left upper limb and right lower limb k/c/o SCA
25/7/2023.
14 year female child who is k/c/o sickle cell anemia came with c/o fever and swelling of left upper limb and right lower limb associated with pain since 3 days
Fever which is of high grade not associated with chills and rigors , cold ,cough, sore throat, chest pain , palpitations,sweating,abdominal pain,vomitings,diarrhoea,decreased urine output .
No h/o hematuria , melena,bleeding gums,petechia,menorrhagia .
HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic 11 years ago (1/4/2012) when she was 3 years old she was admitted in the hospital with c/o fever , cough, vomitings she was diagnosed to have sickle cell anemia (Hb electrophoresis was done) and was given blood transfusion and treated with Inj ampicillin and folic acid
2. On 23/9/14
She was taken to the hospital with complaints of fever, cough ,cold since 1 week and diagnosed with bronchopneumonia ( chest x ray showed left lower lobe consolidation). She was treated with Inj Augmentin and whole blood transfusion was given .
3.on 16/11/15
She was admitted with c/o fever, cough ,cold since 3 days
Ceftriaxone , meropenam and vancomycin was given
Whole blood transfusion was done
4.on 14/11/13
Admitted for fever ,cough, cold since 4 days
Diagnosed with lower respiratory tract infection.
Treatment: cefotaxime (7 days ),azithromycin ( 3 days )
Blood transfusion done
5. Admitted on 4/4/14
C/o cough, cold, high grade fever since 4 days
Diagnosed as SCA with right upper lobe consolidation
Treatment: Inj piptaz (10 days ) , Inj amikacin (7 days )
Inj vancomycin given for 2 days but stopped because of allergic reaction.
6. Admitted on 16/9/14
C/o high grade Fever with chills since 2 days
Diagnosed as SCA with bronchopneumonia
Treatment: 1 mg Augmentin for 5 days
Blood transfusion was done .
7. Admitted on 24/12/14
C/o cold,cough, fever since 2 days breathless since 1 day
Diagnosed as SCA with bronchopneumonia.
Treatment: inj amoxyclav for 7 days .
8. Admitted on 8/7/15
C/o Fever , rapid breathing,cough since 2 days
Diagnosis:SCA with bronchopneumonia
Treatment: inj amikacin for 5 days , Inj Augmentin for 10 days .
9. 6/11/15
C/o cough , cold since 3 days fever since 1 day presented with sob
Diagnosis: SCA with bronchopneumonia.
Treatment: inj ceftriaxone ( 1 day ) meropenam and Inj vancomycin for 10 days
Whole blood transfusion.
Pneumococcal 23 strain vaccine given on 6/11/15
On 20/1/16
C/o Fever, generalised myalgia and arthralgia , pain abdomen
Treatment: inj meropenam for 7 days
Inj vancomycin for 7 days
Admitted on 17/12/19
C/o pain abdomen ( on and off since one month in epigastric pain and left hypochondrium )
Vomitings since afternoon.
Diagnosis: SCA with vasooclusive crisis with acute pancreatitis
Treatment:PIPTAZ for 5 days
Tab hydroxyurea
Admitted on 17/2/2020 Follow up
Admitted on 21/3/2020
SCA with acute pancreatitis follow up
Admitted on 1/2/2022
C/o abdominal pain since 2 days associated with vomitings and epigastric pain ( gradually progressive)
Serum amylase : 944 IU /lit
Treatment: tab cefixime , tab levofloxacin for 5 days
Admitted in GM on 15/7/2022
C/o knee pain since 3 days
Diagnosis: SICKLE CELL ANEMIA with VASOOCLUSIVE CRISIS
Treatment:PRBC transfusion , penicillin g given
Admitted on 20/8/2022
C/o knee pain since 3 days
SCA WITH VASOCLUSIVE CRISIS.
Admitted on 15/3/2022
,C/o pain in b/L knees and loin pain
Treatment: tab penicillin po/od
hydroxyurea .
On 25/7/23
She came with c/o fever and swelling of left upper limb and right lower limb associated with pain since 3 days .
FAMILY HISTORY:
Patients father mentioned that they had first baby boy who died at at the age of 3 due to similar complaints.
She has 2 younger siblings sister and brother
Both are healthy, younger sister was tested for sickle cell anemia and was negative.
No other members in the family have similar complaints.
Sickle cell trait of her parents.
GENERAL EXAMINATION:
Patient is CONCIOUS , COHERENT,COOPERATIVE
Pallor - present
Icterus , cyanosis, clubbing , lymphadenopathy absent
Vitals :
Temperature :98.5 F
Pulse rate : 82 bpm
Bp: 110/60 mmhg
RR:18 cpm
SYSTEMIC EXAMINATION:
CVS : s1,s2 heard no murmurs
RS : BLAE present,NVBS
CNS : NFND
P/A : soft , non tender .
Diagnosis:
K/c/o sickle cell anemia since 11 years with vasocclusive crisis ( left upper limb and right lower limb) pyrexia under evaluation.
Investigations: 25/7/23
Treatment given :
IV fluids 2 NS @ 75 ml / hour
Inj neomol IV/sos
Inj TRAMADOL IV / TID
TAB HYDROXYUREA 500 mg po/bd
TAB SHELCAL PO/bd
TAB OROFER PO/OD
TAB CHYMEROL FORTE PO/TID
TAB PCM 650 mg po/TID
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