Medicine case: 27 yr old female with GERD , Surgical premature menopause , Pyrexia Of Unknown Origin , ? K/C/O Pulmonary Koch's

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CASE PRESENTATION

27 yr old female married at age of 11 years , consanguinous marriage, mother of 2, 1st pregnancy at age of 14 years, 2nd pregnancy at 16 yrs c-section

6 months after c-section pt noticed pain abdomen which is continuous, daily. H/o Irregular menstrual cycles, white discharge

Used medication for regularisation of cycles. This continued for 1 yr and later she underwent hysterectomy (done 1 yr back )

After 20 days pt noticed low grade fever ,nausea,loss of appetite for 2-3 months. Later she was hospitalized for 1-2 days and treated for typhoid (widal test +), fever subsided only with medication and recurred when stopped.

H/o using ATT for 6 months I/V/O low grade fever, after ATT pt felt some improvement

HOPI

C/O low grade fever nocturnal, easy fatiguabality, nasuea since 3 yrs, vomitinngs intermittently,bowel regular, retro sternal heart burn +, regurgitation sym+ , abdominal fullness +, pt avoids food because of nasuea and abd fullness, belching +, generalised weakness, multiple joint pains, early morning stiffness+

No H/O palpitations,SOB,pain abdomen, rash , pet exposure, palpable, no H/O allergies, swelling over body

PERSONAL HISTORY:

Normal appetite

Mixed diet

Sleep adequate

Bowel and bladder regular

No addictions

O/E:

Pt is C/C/C

Moderately built and nourished

Pt is febrile

BP: 100/60 mm/hg