55 yr old with fever chest pain and loss of appetite



This is an online E log book 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 series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box"

 55 year old male, farmer by occupation,  came to OPD with complaints of : 


Chief complaints :-


Fever since 13 days , chest pain since 10 days, and loss of appetite since 10 days

History of present illness:- 
Patient was apparently asymptomatic 8 months ago then he developed fever , cough, shortness of breath on exertion
fever is of high grade associated with chills and rigours diurnal variation ,relieved with medication 
cough was initially dry cough then progressed to productive cough with scanty sputum ( white non-bloodstained type) , non foul smelling . The sputum was more produced during night
Patient was evaluated with Bronchoscopy and diagnosed with the right lower lobe aspergilloma and started on itraconazole (200mg) BD for 6 months patient was recovered symptomatically and was well till the last 13 days 

13 days ago patient developed fever which was low grade, not associated with chills and rigours .
Chest pain was sudden in onset 10 days ago , pain increased with chest movements associated with SOB grade 2 progressed to grade 3
h/o orthopnea is present
no h/o of PND 
Palpitations are present ,excessive sweating is present.
patient was evaluated and found to have LV (left ventricular) strain and treated symptomatically , loss of appetite since 10 days . 


Past history:- 

patient was diagnosed previously by right lobe aspergilloma on Tab itraconazole 200mg BD

No history of hypertension
No history of coronary artery disease
No history of Diabetes 
No history of tuberculosis 
No history of epilepsy
No history of asthma 
No history of previous surgeries

Personal history :- 

Diet - mixed
Appetite is normal
Bowel and bladder - normal and regular
 No Known allergies
Addictions - occasional alcohol 2 pegs once monthly

Family history:- 

No significant family history 

 General examination:- 
Patient is conscious, coherent and co-operative.

Examined in a well lit room.

Moderately built and nourished


Icterus is absent 
 
No oedema   

 pallor present

No cyanosis, clubbing , lymphadenopathy 


















Vitals : 
Temperature- febrile 

Respiratory rate - 28 cpm

Pulse rate - 62 bpm

BP - 120/80 mm Hg.

Spo2 at room air is 96%

GRBS - 102 mg/dl

SYSTEMIC EXAMINATION:-

CVS : S1 S2 heard, no murmurs

Respiratory system : normal vesicular breath sounds heard(vesicular)

Abdominal examination: 

INSPECTION : 

      Shape of abdomen- scaphoid

-No tenderness of abdomen 

Umblicus - normal
Movements of abdominal wall - moves with respiration 
Skin is smooth and shiny

PALPATION : 

No Local rise of temperature

Tenderness absent

Guarding absent 

Rigidity absent 


Fluid thrill absent

Liver not palpable .

Spleen not palpable 

Kidneys not palpable 

Lymph nodes not palpable

RESPIRATORY EXAMINATION:- 

Dyspnoea is present
wheeze is absent
position of trachea is central
normal vesicular breath sounds are heard
no adventitious sounds heard

 CNS EXAMINATION  :- 

Speech normal

No signs of meningeal irritation 

Cranial nerves: normal

Sensory system: normal

Motor system: normal

Reflexes: Right. Left. 

Biceps. ++. ++

Triceps. ++. ++

Supinator ++. ++

Knee. ++. ++

Ankle ++. ++



Provisional diagnosis :-

Aspergilloma of right lung....


INVESTIGATIONS: 















Final diagnosis
Right lower lobe aspergilloma of lung
(Chronic pulmonary aspergillosis)

Treatment:- 

Tab DOLO 650 mg po/ TD
tab itraconazole 200mg po/BD
Tab hifenac BD
Tab Zofer

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