C/o - Sudden onset Inguinal Lymphadenopathy gradually progressing to cervical Lymph Nodes but absolutely painless and asymptomatic since 7 years - IGNORED
Presenting Complaints -
Severe Watery Loose Motions,
Hematology - Hb - 8.3 gm%, ESR - 69mm., Rest - Normal.
Urine - Proteins ++++, BUL - 48 mg/dl, S. Creatinine - 3.16 mg/dl., BSL(R) - 100 mg/dl
On Examination - Dehydration Grade - I, Generalized Lymphadenopathy.
USG Abdomen - Spleenomegaly (16.3 cm) with Abdominal Lymphadenopathy, Mild increase Renal echo. CT Scan Abdomen - Mild enlargement of Spleen with multiple matted retroperitoneal enlarged Lymph nodes.
Cervical L.N. Biopsy - Non Hodgkin's Lymphoma - Diffuse Large cell type.
ADVISED CHEMOTHERAPY & RADIOTHERAPY - Patient REFUSED
Sever sour bitter vomiting, Prostration ++++,
Sensitive to rich fatty oily food, condensed milk, Pruritus all over the body, Absolute anorexia, Depression+++, fear +++, Reduced Urination, Drowsy, Febrile.
O/e- Generalized Lymphadenopathy, bilateral ankle oedema PERFORMANCE SCORE-30
Clinical assessment - slow onset, presence of constitutional symptoms (anorexia, wt loss, fatigue, sweating, fever, pruritus), Anemia (8.3 gm%)
Symptoms suggestive of involvement of extra nodal sites - GIT, Renal, Skin
NHL-Grade IV (Ann-Arbor's staging system)
Relief from acute Symptoms, Depression, fatigue reduced, Appetite increased, Oedema reduced, Itching reduced,
All muscular pains reduced except Rt. neck pain.
Rate of wt. loss reduce to ½ kg./3 wks. over a period of 3 months & stabilized at 55 kg.
Appetite gradually kept on increasing,
Clinically anemia improved.
Current position -
Patient is Absolutely Asymptomatic, Gaining wt. slowly, No constitutional symptoms.
No fatigue, oedema,
Tolerance to condensed milk & oily food increased,
USG suggestive of no further metastasis.
Has had NO ACUTE INFECTION in past 7 months.
All the Lymph Nodes have reduced in size, most of them are not palpable & the consistency has become very soft.
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