A 60 YR OLD MALE WITH FEVER SCROTAL SWELLING AND DEPRESSION
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Chief complaints-
A 60 year old male patient teacher by occupation, was brought to casualty in a drowsy state 2 days ago, fever since 3 days , vomitings since 2 days.
HOPI:
Patient was apparently asymptomatic 30 years back then he had fever, following which he went to a local hospital where he was given an injection and since then he was feeling that something is happening to him for which one of his relatives took him to a psychiatrist and got treated and was given Tab. Fluoxetine.
H/o giddiness 26 years back for which patient went to a local hospital and got diagnosed with hypertension and was started on Tab. ATEN-AM 50/5 mg OD.
During a routine health check up 20 years back , patient was diagnosed with Diabetes mellitus and started using Tab. Glimi M1 OD
H/o gradual painless diminision of vision 10-15 years back for which the patient consulted an ophthalmologist and was diagnosed with cataract and underwent cataract surgery.
Patient retired 2 years back, and stopped taking DM and HTN medication as he thought he was feeling well
One month back , his daughter committed suicide for which he got disturbed psychologically and started excess consumption of alcohol.
He complained of itching in the scrotal region 10 days ago following which he developed swelling over the scrotum associated with pus discharge. He took medications without physician consultation.
Patient now presented with h/o fever since 2 days, low grade, intermittent and relieved on medications.
Not associated with pain abdomen, no SOB, associated with generalized weakness.
Past history:-
H/o DM since 20 years and is on Tab. Glimi M1 OD
H/o HTN since 25 years and is on Tab. ATEN- AM 50/5 mg OD
Treatment history-
Personal history:
Alcoholic since 30 years occasionally consumes 2 pegs per day
Non vegetarian, good appetite, adequate sleep, bowel and bladder movements regular.
GENERAL EXAMINATION:-
Patient is concious, coherent and cooperative
Moderately built and nourished
Delay in obeying commands
Pallor icterus clubbing cyanosis lymphadenopathy pedal edema not seen
Vitals:-
Temp:- Afebrile
BP:- 100/80 mmhg
PR:- 80 bpm
RR:- 22 cpm
Spo2- :- 99% at room air.
GRBS- 95mg/dl
SYSTEMIC EXAMINATION:-
CVS- S1, S2 heard, no murmurs
RS - Bilateral air entry present, NVBS heard.
Per abdomen:- Soft, non tender
Scrotal abscess surrounded by induration is present
A 3×2 cm necrotic patch over scrotum
Pus discharge +
CNS:- NFND
Surgical referral is done.
Before debridement:
After debridement
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