65/M came with SOB and anuria

65/M who is a resident of yadagiri gutta.. Toddy tree climber by occupation 20 years since he stopped that work and started doing some settlement works where clients used to give him some money/alchol for the work done.. Before january his routine work used to be early morning he used to wake up around 5 am and went for jogging.. Later after his routine activities he used to go for work and there starts the consumption of alchol approximately 180-360ml/day and also toddy sometimes.. He comes to home by 8-9pm where he have some food and goes to sleep.. On jan 1st 2022 while he is coming to home after consumption of alchol he had fall to right side.. For which he had? hip surgery.. Since then he has decreased his alchol frequency to once in 2-3 days with decrease in his routine work.. Since then when he walks for long distance/duration he used to complaining of fever for which he takes paracetmol and fever will be relieved.. 20 days back he has taken first dose of covid vaccination since then he is c/o high grade fever associated with chills and rigor, on and off and 3-4 episodes of vomitings and subsided after taking medication not associated with aany loose stools .. He was shown to near local rmp where he given some antipyretics but still fever hasn't resolved.. But on routine examination and investigations 1 week back patient found to have thrombocytopenia (1.16L) with raise in total bilirubim 1.8..  With cue showing pus cells around 10.. And again since 2 days patient c/o sob and abdominal distension and went for review where he found to be having bilirubin of 2.4 and prescribed some herbal medication for jaundice and patient went home.. Since yesterday morning pt c/o reduced urine output where again they went to local hospital showing platelets 30000 and total bilirubin 12.6,and enzymes are in normal range and came to our hospital for further management

IS NOT A K/N/C/O DM HTN ASTHMA CAD EPILEPSY HYPOTHYROID

At presentation 
Patient is drowsy but arousable
GCS E3V4M5
Afebrile 
BP - 120/80 mmhg
PR - 110bpm
CVs - S1S2+ 
RS - BAE+ clear
P/A - diffuse tenderness noted 
CNS - severe myalgias noted with muscle tenderness noted
Unable to perform complete neurological examination as he is having severe tenderness

Provisional diagnosis:
Pyrexia under evaluation ? Meningitis? Leptospirosis with acute kidney injury and acute liver injury.. With hyponatremia and hyperkalemia with thrombocytopenia

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