A RARE CASE OF FEVER WITH THROMBOCYTOPENIA

26 YEARS OLD MALE PATIENT PRESENTED WITH 10 DAYS OF FEVER.ON PRESENTATION PATIENT HAD DARK COLOURED URINE , THROAT PAIN WITH GENERALIZED BODY PAIN.ON EXAMINATION PATIENT HAD PURPURIC SPOTS , CONGESTED UVULA , PHARYNGIAL WALL AND PALATE.PATIENT STRIKINGLY HAD GROSS EDEMA OF THE NECK REGION.INTIAL LAB INVESTIGATIONS REVEALED GROSSLY ELEVATED SGOT 1938AND THROMBOCYTOPENIA WITH NORMAL SGPT AND LFT VALUES . FEVER PROFILE WAS NEGATIVE .USG NECK REVEALED EDEMA OF THE SUBCUTANEOUS TISSUE AND MUSCLES.NEXT DAY PATIENT DEVELOPED GENERALIZED EDEMA WITH WEAKNESS OF ALL FOUR LIMBS AND SEVERE MUSCLE PAIN. FURTHER INVESTIGATIONS REVEALED GROSSLY ELEVATED CPK LEVEL AND EMG FINDING SUGGESTIVE OF MYOSITIS .ANA BY ELISA AND WESTERN BLOT WAS ALL NEGATIVE. PATIENT WAS STARTED ON INJ.METHYLPREDNISOLONE. AS THE PATIENTS SPO2 DECREASED , PATIENT WASINTUBATED AND WAS PUT ON VENTILATOR.SWELLING AND TENDERNESS DECREASED ON DAY 10 OF ADMISSION. PATIENT WAS TREATED WITH PLATELETS AND OTHER SUPPORTIVE MEASURES. OTHER CO-MORBID CONDITIONS THAT DEVELOPED DURING THE HOSPITAL STAY WAS TAKEN CARE OF. PATIENT RECOVERED.PATIENT WAS PUT ON T.METHOTREXATE AND T.AZATHIOPRINE AND TAPPERING OF STEROIDS DURING DISCHARGE. REGULAR FOLLOW UP WAS ADVISED. LESSONS LEARNT ALL FEVER WITH THROMBOCYTOPENIA SHOULD NOT BE THOUGHT AS INFECTIOUS ALONE.CONNECTIVE TISSUE DISORDER THOUGH A RARE ENTITY SHOULD BE KEPT IN MIND AND TIMELY INTERVENTION CAN PREVENT LIFE THREATINING COMPLICATIONS OF THIS DISORDER.