63F with Right knee joint septic arthritis(?secondary to femoral vein catheterisation)


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Here is a case i have seen
63 Y F resident of aaliyah (kaatala village) Tailor by occupation came with c/o 
lower back ache , pain and swelling of right knee joint with 1 episode of fever .
HOPI:
Patient was apparently asymptomatic 20days back.Then she developed
vomitings(2 episodes ) only for one day, fever since 20 days and multiple episodes of loose stools (20 episodes ) 20 days back with pedal edema, Swelling and pain of right knee joint since 4 days . Decreased urine output for 2 days for which she got admitted in a private hospital.There she got dialysis done for 3 times
because of severe sob ,raised serum creatinine (4.5mg/dl).


After 5 days because of affordability issues ,she went to government hospital.There she got compression bandages for right limb till knee for 4 days. Later she went home .
After 2 days of discharge she developed:
 lower back ache which was insidious in onset ,non progressive,aching type,no aggrevating and relieving type.
pain in right knee joint , pricking type,no aggrevating factors and relieving factors. Swelling in the right knee joint, gradually progressive,local rise of temperature and tenderness +, associated with pain , restriction of movements present.
1 episode of fever + for which she came to hospital.
No hl0 trauma.No H/o headache, blurring of vision,vomitings,loose stools.No h/o burning micturition,haematuria, pain abdomen.
No h/o sob ,chestpain, palpitations.
No h/o prolonged immobilisation.
Past history:
No similar complaints in the past.
Patient is k/c/o DM 2and HTN since 25 years on medication [ glimipiride 1mg OD and Atenelol 50 mg OD]
No h/o TB,ASTHAMA, THYROID ABNORMALITIES,CAD.
O/e: pt is c/c
Vitals 
Temp :Afebrile
Bp:100/70
Pr :80bpm
Rr:20cpm
No pallor, icterus, cyanosis clubbing lymphadenopathy,pedaledema
CVS: S1, S2 heard, no murmurs
Respiratory system: Bilateral air entry present, normal vesicular breath sounds heard, no added sounds heard
P/A : soft,non tender
CNS: NAD

on 28/12/20

Provisional diagnosis:
Right knee joint septic arthritis.(?secondary to femoral vein catheterisation)
K/c/o DM 2,HTN since 20years
AKI resolved 1month back ( HUS ? Secondary to E Coli with hypoalbunemia.
Treatment:
1.Inj.Tramadol 1 amp in 100ml Ns
2.tab.ultracet 1/2 qid.
3.inj.pan 40 mg iv 
4.inj.monocef 1 gm iv bd
5.inj.human actrapid insulin sc





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