patient presenting with hypoxemia and normal cxr Posted By Dr Alok Sinha Date : 04-Aug-08
A 45 year old lower middle class Nepali women presented with H/O of fevre on & off with vomitting and pain abdomen for 3 months.Intially treated for Enteric fever with Ciprofloxacin by local doctors. USG abdomen showed spleenomegaly-mild. Was admitted in hospital at Pokhara, Nepal on 13.07.08. O/E patient was breathless with respiration >27/min with alae nasi contracting prominently. CXR -picture 1 above-was within normal. Oxygen saturation <65% which improved with Oxygen inhalation. TLC-3900,P-86%,L-12%, ESR 42. She was treated as a case of Cholangitis with septicemia with broad spectrum antibiotics-Methicillin, Ceftriaxone & Metronidazole. Her Condition detoriated and repeat cxr-picture 2-showed bilateral patchy shadows on 26.07.08. Repeat ultrasound showed minimal rt sided Pl effussion. Was started on ATT.Condition detoriated and wae shifted to ICU on 29.07.08 where she expired next day. All other routine investigations-blood sugar,LFT,RFT were normal.