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


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 is welcome.

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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