43 years old man a known case of diabetes Mellitus, hypertension, Rheumatic heart disease with recently underwent closed balloon mitral valvectomy. Had post-circulation stroke. 6 months back on insulin, antiplatelet therapy, penicillin prophylaxis. presented with fever for past 25 days lab investigation shows persistent platelet count 30000, total count 3000, haemoglobin normal, bone marrow shows granuloma haemophagocytosis, USG abdomen shows minimal peritoneal minimal lt pleural effusion, ESR increased, Dengue Antigen negative, HIV negative, blood wider borderline positive, Leptospira negative, malarial antigen negative.
Patient on empirical ATT drugs for past 10 days. Still fever didn't subsides, platelet 25000 and Hyponatremia. Clinically how to approach this patient.
