82 year old female with fever and knee joint pain

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Patient is a  82 year old female ,housewife,resident of Bidar, came to the casualty with complaints of : 

Cheif complaints:

 •Knee joint pain on both legs since 2 days

•Fever since 2 days

History of presenting illness:

Patient was aymptomatic 20 days back. Then she developed knee pain on both sides associated with fever for which she was admitted in  hospital and discharged and diagnosed with Iron deficiency anemia.Since 6 days she had fever which relieved on medication and replases back.

H/o similar complaints 20 days ago and was admitted to our hospital Diagnosed to have synovitis of right knee (resolved),with right lower lobe pneumonia(resolved)with bilateral knee osteoarthritis with IDA

And was discharged 1 week ago

History of past illness

K/C/O Hypertensive since 10 years.

On medication-TELMISARTAN 40mg

(Used AMOXICLAV and DIETHYL CARBAMAZENE for 2 weeks)

N/C/K of Diabetes, epilepsy, tuberculosis cardiovascular disease

Personal History

Married

House wifet

Diet:Vegetarian

Appetite: Reduced

Bowel bladder moments: regular

Addictions : No

Family history:

No other family member had similar complaints 

Menstrual history 

Menopaus- 35 years ago

On examination

Pt is conscious,coherent and cooperative well oriented to time,place,person 

 Pallor-Mild grade

     

No signs of  icterus,clubbing,cyanosis,lymphadenopathy ,pedal oedema

Vitals

Temp:102°F

PR: 110

Rr: 24/ min

Bp:120/70 mm Hg. 

Spo2: 94%

Systemic examination

CVS: S1,S2 heard, no murmurs heard 

RESPIRATORY SYSTEM;

B/l symmetrical chest

Trachea - Central

B/l air entry present

NVBS heard

Inspiratory crepts heard

ABDOMEN:

Shape of abdomen: Scaphoid

Soft, non tender.

No rigidity or guarding.

BS+

CNS

Normal and intact

Investigations

XRay knee joint

Chest X-ray

        

Synovial fluid analysis- 

TLC- 16,000 CELLS/cumm

DLC- 100% NEUTROPHILS

USG B/L knee:

       

ORTHO REFERRAL:(done on 28/6/23):

Diagnosis:grade 4 B/L OA knee

Impression:

Degenerative changes noted in B/L knee 

Mild joint effusion in Rt knee

Mild to moderate effusion in lt knee

B/L synovium thickened in both knees 

Advice:

INJ.antibiotics as per physician 

T.ultracet PO/BD

T.pan 40mg PO/OD

Quadriceps strengthening exercises

Provisional diagnosis: 

 Pyrexia,Septic arthritis, Iron deficiency anemia,

Bursitis

FINAL DIAGNOSIS:

Pyrexia(resolved) with polyarthralgia 

B/L Non inflammatory synovitis secondary to OA 

B/l(left>right)cerebellar?atrophic lesion under evaluation 

B/L symmetric sensory,motor peripheral neuropathy (L1-S1)

With iron deficiency anaemia 

with K/c/o HTN since 10yrs

Treatment History 

IV Fluids Normal Saline 50ml/hr

Inj.NEOMAL 1gm IV stat

Tab.DOLO 650 mg TID

Tab.TELMA AM 40/5 mg

Tab. OROFER xt