Day 50 : The Obese COPD patient with repeated LRTI

Sunday 20/11/22 Adarsha Hospital,Kundapura

Duty on Sundays is always boring. Started my day good I met my old neighbour and childhood teacher Pushpa aunty. She came with c/o weakness and during blood test her Hb was low and treated accordingly. Also met my Childhood Kannada teacher Nagaraj sir. He came to show his mother for regular checkup.

But the day was boring since no good and interesting cases came. But a patient who visited on OPD basis was little interesting.

The Patient was Mrs. Bibi Hannisa, middle aged women k/c/o HTN,T2DM,CKD,COPD presented with c/o Fever with chills, generalised weakness since 3 days. She is Obese and had been admitted previously for similar condition in our hospital. She always gets repeated LRTI.

On examination, She had B/L Rhonchi+. Sir ordered some blood tests,CXR and ECG.

When her lab reports came, it shower that she has severe infection. Her WBC was 23,000 u/L with raised nuetrophil levels (80,000u/L). Her RFT was slightly raised Sr. Creat - 1.7 mg/dl. ESR was raised to 99mm/sec. All the serology tests like Dengue,Widal and Lepto was negative. CXR looked hazy.

She was advised for admission with antibiotics choice of Inj.ISZU FORTE 1.5gm and Inj Metrogyl 500mg IV with other supportive treatment. Inj SPIROMIDE 1cc with 10cc NS IV was also adviced. No fluids were given to avoid fluid overload.

She has been treated as LRTI.

Recognised clinical phenotypes of chronic obstructive pulmonary disease, asthma, and bronchiectasis

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Day 57 : Right toe ulcer with TAO ( Buerger's Disease)

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Day 48 : A large right lower limb swellling with cellulitis , Filariasis

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