A 65-year old patient from rice farming background is recently admitted with swelling of ankles and pain, redness on the right ankle for 7 days. The patient is also showing a fever, cough, breathlessness from last 1 month. Patient was treated with ceftriaxone for fever, when Widal test was found reactive. The patient was also diagnosed for diabetes mellitus at the same time. On treatment, though his symptoms subsided to some extent, since last 7 days developed of high fever, worsening breathlessness and loss of appetite. He was admitted to hospital for further management.
Physical examination He was toxic, febrile, icteric, and dehydrated. Body temperature 102° F, blood pressure 90/70mm Hg. respiratory rate 50/min, and heart rate 128/min. Spleen is mildly enlarged without free fluid in abdomen. The ankles were erythematic and oedematous. His right foot had cellulites with pustular…
