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Case of the week

감염내과 R1 나지선. Case of the week. Case presentation. C/C - coughing(O: 내원 7 일전 ) Age/sex - 21/F. Case presentation. Present illness - 내원 7 일전부터 febrile sensation, myalgia 동반한 coughing - influenza A H1N1 RT PCR positive 의 소견으로 Oseltamivir 복용하고 증상 호전

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Case of the week

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  1. 감염내과R1나지선 Case of the week

  2. Case presentation • C/C - coughing(O:내원 7일전) • Age/sex - 21/F

  3. Case presentation • Present illness - 내원 7일전부터 febrile sensation, myalgia 동반한 coughing -influenza A H1N1 RT PCR positive의 소견으로 Oseltamivir복용하고 증상 호전 - 투약 4일째인 내원 3일전부터 밤이면 더 심해지는 양상의 dry coughing 소견 다시보여 이에 내원함

  4. Case presentation • Personal Hx. • Occupation: student • Smoking: no • Alcohol: no • Herb: no • Family Hx. • N/C • Past Hx. • HTN (-) • DM (-) • Hepatitis (-) • Pul. Tuberculosis (-) • Thyroid disease (-) • Malignancy (-)

  5. Physical examination • Vital sign • BP 100/60mmHg • HR 68/min • RR 20/min • BT 37.1℃ • Skin • N/C • Head • Nomocephaly c scar or wound • General appearance • Acute ill looked appearance • Mental state • Alert

  6. Physical examination • Eye • Light reflex (+/+)c isocoria • Anemic conjunctiva(-) • Icteric sclera(-) • Lens opacity(-) • ENT • Grossly free • Neck • Venous engorgement(-) • Lymphadenopathy(-) • Palpable mass(-) • Stiffness(-)

  7. Physical examination • Chest • Crackle (+) (Rt) • Bilateral symmetrical expansion • Wheezing (-) • Heart sound: regular beat murmur (-) • Abdomen • Abdomen distension (-) • Bowel sound- intact • Tenderness (-) • Rebound tenderness (-) • Stroke tenderness (-) • Organomegaly (-) • Palpable mass (-) • Garding/rigidity (-/-)

  8. Physical examination • Extremities • Defomity (-) • Varicosity (-) • Pitting edema (-) • Neurologic exam • DTR (++/++) • SAR (+/+) • Barbinsky sign (-/-)

  9. Problem list • coughing • Known influenza A H1N1 • Crackle

  10. Impression • Viral pneumonia • Influenza secondary infection • Bronchiolitis

  11. Chest PA

  12. Lab. finding • CBC • WBC/Hb/Plt. 23540/14.0/297K (neutrophil: 89.5%) (4000-8000/12-16/ 150K-400K) • Electrolyte • Na/K/Cl 136mEq/L/4.1mEq/L/108mEq/L (136-146/ 3.5-5.0/98-110) • Chemistry • AST/ALT/T-bilirubin/Albumin 21U/L/26U/L/0.77mg/dL/4.6g/dL (5-40/5-40/0.2-1.4/3.8-5.3) • BUN/Cr 6.3mg/dL/0.92mg/dL (7.8-22.0/0.6-1.4)

  13. Lab. finding • ESR/CRP 48mm/hr/13.10mg/dL (0-20/ 0.0-0.5) • PT/aPTT 12.5sec/31.7sec (9.4-12.5/28.0-44.0) • Multiplex RT-PCR positive

  14. Thorax CT

  15. HD#2 • CBC • WBC/Hb/Plt. 10570/11.8/431K (neutrophil: 68.9%) (4000-8000/12-16/ 150K-400K) • ESR/CRP 48mm/hr/8.10mg/dL (0-20/ 0.0-0.5) • Multiplex RT-PCR influenza A H1N1 positive

  16. Sputum culture

  17. HD#5 • CBC • WBC/Hb/Plt. 6770/12.0/431K (neutrophil: 51.3%) (4000-8000/12-16/ 150K-400K) • ESR/CRP 48mm/hr/2.10mg/dL (0-20/ 0.0-0.5) • Multiplex RT-PCR negative

  18. HD#5

  19. Final diagnosis • Influenza A H1N1 • Pneumococcal pneumonia

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