Patient's Name: ABELMOSCHUS160017ESCULENTUS
A 28 Y old female resident of durgapur came to hospital on 22nd may 2017 with the chief complaint of altered sensorium, slurring of speech, drowsiness and since 1day.
Patient was apparently alright 1 year back around April 2016, it all started after caesarean section of pregnancy where she had developed bleeding, after 1 hour she developed flushes and anasarca. At that time she passed only 650 ml of urine.
After transferring to a higher centre where she was diagnosed as AKI (Acute Kidney Injury). She was given haemodialysis for 1.5 months. During this she developed sepsis for which she was given meropenem injection.
In the month of June she was given 1 unit of blood as her RBC were decreased.During July and august she developed DVT in the femoral vein that had a hemodialysis catheter inserted in it.
After that she developed restlessness, slurring of speech for which she was admitted to hospital where she has undergone 3 cardiac arrests and she survived all the three. After few days she got discharged. During this stay the blood sugar was fluctuating, difficulty in speech and drowsiness developed.
From December peritoneal dialysis has started and still on it.
After that in February 2017 she lost her left. eye and replaced with artificial eye.
After that she also developed hospital acquired psychosis for which quitipine is given
On General Examination;
Patient is conscious, disoriented to time place and person
Examination:
MMSE couldn't be done because of the patient not able answer the questions
Right Left
Knee Jerk Normal Absent
Ankle jerk Normal Normal
Plantar reflex Normal Normal
Biceps Jerk Normal Normal
Triceps Jerk Normal Normal
Brachioradialis Normal Normal
Investigation:
MRI:
CT Scan:
This patient is readmitted in ICU with a repeat seizure and recurrent hypoglycemia. His problems are persistent hypoglycemia in the background of Recurrent multi organ thrombii due to a suspected inflammatory pathology like Apla syndrome involving brain (stroke occipital parietal) , eyes(panuveitis and loss of one eye) , kidneys (persistent azotemia on regular CAPD and nephrotic proteinuria with anasarca) for which she was put on prednisolone of 30 mg once daily but was recently rapidly tapered off. It was thought that her recent hypoglycemia was due to hypocortisolism due to the recent rapid taper of steroids.
Below is the culture taken from the mouth of the tube connecting the pd fluid bag and grew this interesting organism resistant to colistin but sensitive to carbapenems. Now to refute the existence of this organism inside her body we shall need to do her ascitic tap! What is the protocol for collection of pd fluid culture to avoid such a problem again?
Disclaimer:-
This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here after collecting informed patient consent.
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