Wednesday, June 12, 2013

CASE: Low grade fever and Progressive weight loss

This case is presented to us less than a year ago. Loopholes are still there and a bunch of differential diagnoses are made.

I will be enumerating the important points here:
History of Present Illness:
  • easy fatigability on minimal activity
  • difficulty of breathing when doing household chores
  • enlarging lymph nodes in neck area
  • unproductive cough
  • intermittent low grade fever
  • progressive weight loss
Past Medical and Personal History:
  • treated for Hodgkin's lymphoma when she was 17 years old
  • given MOPP chemotherapy regimen and mantle radiation therapy
  • works in a paint factory for over 20 years
Physical Examination:
  • in moderate respiratory distress, RR: 25/min
  • HR: 120 beats/min, Temp: 37.8 Celsius
  • Pale palpebral conjunctivae
  • Anicteric sclerae
  • (+) multiple lymph nodes on left side of neck (largest is 2cm in diameter)
  • decreased breath sounds both lower lung fields
  • decreased tactile and vocal fremitus
  • liver palpable 3cm below right subcostal margin
  • obliterated Traube's space
  • pale nailbeds


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