50 year old male with weakness

http://drkulkarnimd.blogspot.com/2022/07/36m-with-decreased-appetite-nausea-and.html


Patient came with complaints of 
C/O weakness and fatigue since 3 days
Unable to lift his rt upper limb since 3 days
History of fever 2 days back
Swelling of lower limbs from 2 days

Fever : low grade 
No diurnal variation
Duration 1day
Associated with chills 
Subsided after taking medication
Not associated with cough and cold 
Not associated with loosestools.
? Burning micturation present

Weakness of rt upperlimb
Pain + @ right shoulder
Inability to move since 4 days
Able to move his fingers and forearm
Not history of trauma or lifting heavy weights
No radiation of pain to neck and chest

Swelling of lower limbs
Bilaterally present grade 1 [pitting type]
History of pedal edema on and off present past 1 year
Not associated with sob , pnd, chest pain, Palpitations,

Patient is a known case of DM since 2 years , was on HAI and NPH given by her wife at lateral aspect of arm and on thighs 

Alcoholic since 15 years
Last binge on


Investigations:
24/9/22

Hemogram showed 
Hb 6
Tlc 15k 
Plt 36k
Mchc
Serum iron
Ferritin
Creat 4
Urea 126
Na 123
K 
Cl
Cue showing 

Usg abdomen showing


Urology referal done i/v/o 
Transition bladder carcinoma

25/9/22
Hb 5
Tlc 18k
Plt 86k
Urea 136
Creat 5

Xray shoulder 
Ortho referal done 

Gross specimen urine
26/9/22






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