56 year old male with generalised lymphadenopathy

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 A 56 year old male, daily wage labourer came with c/o

• Pain abdomen since 20 days
• Multiple masses per abdomen since 1 week
• Fever (high grade) associated with chills and rigorous since 1 week.

History of presenting illness :

Patient was apparently asymptomatic 5 months back, then he developed dry cough which was sudden in onset, gradually progressive. Later he had fever - high grade, associated with chills and rigor.

He went to the hospital for the above complaints - fever was relieved with medications no replased after stopping the medicines.

Patient observed loss of weight and loss of appetite and 2 months later on advice of a govt doctor he got tested for Kochs and HIV - report was positive and was started on ART and ATT.

He now came with c/o abdominal discomfort, pain in periumbilical region a/w multiple masses felt over abdomen with fever, chills and rigor.

No h/o burning micturition

No c/o cough or SOB.

Vitals :

Temp - Afebrile

PR - 88 bpm

BP - 110/80 mm Hg

RR - 18 cpm

GRBS : 106 mg/dl

General examination :

Patient is conscious, coherent and cooperative 

No pallor, Icterus, Cyanosis, Clubbing

Lymphadenopathy + (Multiple palpable lymphnodes in neck and per abdomen)

Systemic examination :

CVS : S1 S2 +

CNS : NAD

RS : BAE +, Clear

P/A : soft, Non tender. Multiple lymphnodes palpable

Provisional diagnosis :

Fever with generalised lymphadenopathy 

?TB ?LYMPHOMA with RVD

Investigations:

Treatment :

T DOLO 650mg PO/TID

T MVT PO/OD

Inj NEOMOL 1g IV/SOS

Surgery referral :