A 35 year old female came to OPD with chief complaints of fever and joint pains since 10 days.

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Chief complaints:-

Patient came with chief complaints of fever since 10 days and joint pains since 10 days.

History of presenting illness:-

Patient was apparently asymptomatic 33 years back Then she had history of seizures when she was 6 months old, 5 to 6 episodes of seizures till she was 2 years.

 12 years back she had abnormal uterine bleeding, most probably fibroid for which she has undergone hysterectomy.

3 years back she developed high grade fever which was intermittent type, she usually gets fever in the morning and evening, it is associated with severe joint pains and not associated with chills and rigour for which she went to nearby hospital and was treated.( this was in June to August 2020).

Again in the year 2021 ( June to August) she had an another episode of fever and was associated with joint pains, for which she went to nearby hospital and was treated.

On 23rd July 2022 she came to KIMS with similar complaints of fever which is high grade, intermittent, associated with severe joint pains (especially wrist joint, ankle joint, knees joint ), not associated with chills and rigour, not associated with burning micturition.

Fever is associated with morning stiffness.

She has non productive cough along with fever.

She complaints of weakness from past 3 years.

No history of headache, dizziness.

Past history:-

Patient is not a known case of hypertension, DM, TB, and any thyroid abnormalities.

She had history of hysterectomy.

Personal history:-

Diet - mixed 

Appetite- decreased 

Sleep- inadequate 

Bowel and bladder movements - regular 

Addictions- nil

No significant family history.

Treatment history:-

General examination:- 

Patient is conscious, coherent, uncooperative and well oriented to time, place and person

Moderately built and moderately nourishment.

BP - 100/80 mm/hg

PR - 74 bpm

RR - 16 cpm

Temperature - 102 degrees Fahrenheit.

No pallor, icterus, cyanosis, clubbing, lymphadenopathy.

She has tenderness and swelling over the wrist joint and knuckles.

Systemic examination:-

- CVS:- S1, S2 heard and no murmurs.

- RS :- B/L NVBS

- per abdomen:- soft , no tenderness and no palpable mass.

- CNS:- no focal neurological defects.

Provisional diagnosis:- 

Acute febrile illness with reactive arthritis.

Investigations:-

X - Ray:-

Ultrasound report:-

ECG:-