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latest on Covid

Left lumbosacral radiculo-neuropathy with left lower limb DVT with septic shock, Gram negative sepsiswith Acute kidney injury on Chronic kidney disease with reactive left knee arthritis with right ethmoidal fungal sinusitis ( fungal ball – Aspergillus  ) in a  Known case of Diabetes, Ischemic heart disease, post CABG, post Ca Colon, advanced glaucoma and Post COVID fibrosis. 
Mr S N P, 77-year old male known case of Diabetes, Ischemic heart disease – post CABG status 2013, post Ca Colon (2014 - post chemo andpost-surgery), Post COVID fibrosis (COVID- SEVERE SARI - October 2020), had history of fall few days back followed by pain in left side of the leg, admitted with complaints of fever with chills and left lower limb acute pain associated with weakness since last 2-3 days.
 He was admittedon 07/05/2021 for the same complaints. CT chest + abdomen with oral and IV contrast. MRI Thoracolumbar spine with Cervical spine screening with MRI brain diffusion weighted images done on admission to rule out any infective focus for the sudden onset of fever, chills and acute leg pain and weakness. MRIspine was suggestive of acute collapse / compression fracture of D12, MRI brain was s/o age related changes.CT scan chest and abdomen showed post covid changes.Lab test showed very high CRP (373) which suggests severe bacterial infection .Patient was off oxygen and maintaining 95-96% saturation on room air on admission in hospital.
Next day in the evening; he had sudden fever with chills with Oxygen dropped upto 85% and was started on oxygen supplementation and symptomatic treatment.  He was staredon antibiotics. His urine and blood culture both showed presence of different bacteria who were resistant to multiple antibiotics hence antibiotics were changed as per culture report. Even after 48 hrs,he continued to have similar episodes of chills in the evening. His repeat CRP was 393 with procalcitonin of 38 which was suggestive of bacterial sepsis. He was shifted to ICU in view of low oxygen and low BP. In the ICU,he was continued on same antibiotics and other supportive treatment to increase BP and oxygen. He also continued to complaint left side ofleg pain for that orthopedic reference was also made. On investigations he was found to have clot (thrombus) in left leg.He was started on blood thinner (oral anticoagulants) for the same. 
Three days stay in ICU he settled down and required 2 liters of oxygen with normal blood pressure and shifted to the ward.He was continued on same line of treatment, antibiotics, oxygen along with supportive treatment.  After 2 days he had multiple loose stools with increasing breathlessness and repeat test was suggestive of again increase in infection (CRP 361).Also his left knee was red, warm, severely tender? Reactive/ septic arthritis.Stool sample sent for testing culture and shifted to ICU again for monitoring. 
After 24 hours his knee was better with minimum tendernessand no redness. Orthopedic doctor advised to continue only with physiotherapy. After 48 hours patient shiftedback to ward. He continued to improve in the ward, completed two weeks of high end antibiotics and then switched over to oral antibiotics. He was also referred to Ophthalmologist for his pre-existing glaucoma and continued on the topical eye drops Patient continued to improve and about to discharge. His urine catheter wasremoved and he was mobilizedin the ward. CRP came downto 128. Next day morning, he complained of nose block. On examination and investigation he was found to have Nasal sinus block (Rhinosinusitis)? fungal ? mucormycosis. Next day he was taken for sinus surgery. Histopathology suggestive of Aspergillus, sopatient started on antifungal drugs. Patient remained stable and discharged with stable condition. 
On discharge, patient was fully conscious, oriented mobilized in the ward. No fever since last more than one week and was maintaining oxygen saturation at room air with stable vitals.
On follow up in OPD after one week, patient continued to improve. CRP came down to 60 with no new symptoms, oral antibiotics were stopped and oral Voricaonazole were continued for next 3 weeks. Patient continued to improve as per the last followup.