GENERAL INFORMATION: Peter Jackson 76 year old male, Liberian presently residing at Gardensville , Monrovia, Liberia. Initially sought consultation 30 May 2012. CHIEF COMPLAINT: Blood Urine HISTORY OF PRESENT ILLNESS Present condition started 2 weeks prior to consultation in May 30 2012 as intense headaches, back and abdominal pain, fever, chills, nausea, and blurred vision. Also noted is flushing of the face, inflammation or redness of the eyes, and rashes on the anterior chest wal... Patient was given medications in the form of paracetamol 500mg 1 tab t 3 times a day. Patient underwent a series of laboratory examinations in June 1, 2012 which revealed elevated Triglycerides 198 mg/dl (Reference; 40-165 mg/dl) and Positive PSA 10ng/ml (Prostatic Serum Antigen) ( Reference: <4 ng/ml). Patient was referred to a surgeon for surgical evaluation of the prostrate gland. Surgical advice was given noting no intervention was needed at the time of examination. On August 21, 2012 Patient came back for complaint of pain on urination and increase frequency of urination. Patient was noted have a urinary tract infection and was treated with antimicrobials. A subsequent follow up on August 27, 2012 showed improvement in with no dysuria on interview, Patient was advise to complete the antimicrobial medication and to come back September 1, 2012. Patient sought consultation on September 15,2012 complaining of pain on the urethra. Patient was prescribed Deoxcyline 100mg I capsule bid for 14 days. To come back on September 29,2012. On October 4,2012 patient compained of the inability to urinate and passaged of bloody urine. An home visit was and complete renal function test was done revealing normal chemistry examination. Patient was admitted to Catholic Hospital were no diagnosis or prognosis was done. Monitoring of renal function was done by International Polyclinic showing initially abnormal renal function results and the patient had episodes of low blood pressure, and decrease urine output PHYSICAL EXAMINATION: BP: 80/60 CR: 80/minute RR: 18/minute HEENT: Pale palebral conjunctiva, no tonsillo pharyngeal congestion CHEST/LUNGS: Clear breath sounds, No rales , No wheezes. Noted are maculo papular rashes on the anterior chest wall. HEART: Normal rate regular rhythm no murmurs ABDOMEN: No organomegaly, normal bowel sounds, (-) kidney punch , EXTREMITIES: Pitting Edema ++ ankle bilateral With in dwelling catheter and bloody urine at the time of examination. MEDICATIONS: Ampicillin Capsules 500mg three times a day Paracetamol 500 mg two times a day Vitamin C 1 tablet twice day PERTINENT LABORATORY EXAMINATIONS: Complete Blood Count: HgB 12.9 g/dL Hct 35% RBC 4.5 x 106 WBC 10.5 x 103 Differential Count Segmenters 63 Band 0 Lymphocytes 35 Monocytes 0 Eosinophiles 2 Basophiles 0 Platelets 100 x 103 URINALYSIS: Bilirubin 3umol/L Glucose Negative Ketone 9 mg/dL pH 4.9 Protein 99 mg/dL RBC’s 4 RBCs/HPF WBC 10 /HPF Specific Gravity 1.029 Urobilinogen 7.99 umol/L `IMMUNOLOGY: H. pylori test (+) Falciparum (+) VDRL (-) STOOL EXAMINATION: E. histolytica Cyst (+) Peripheral Smear: July 4, 2012 Peripheral smear reveals microcytic hypochromic red blood cells. White blood cells are increased with neutrophilic predominance. Toxic granulation is noted Platelets are decrease. No malarial parasites were noted on the examination of the smear. BLOOD CHEMISTRY June 1 ,2012 Chemistry Test Results Reference Values Creatinine 3.9 mg/dl 0.5-1.1 mg/dl Blood Urea Nitrogen 92 mg/dl 14-45 mg/dl Blood Uric Acid 4.0 mg/dl 2.4-7.0 mg/dl Cholesterol 212 mg/dl <200 mg/dl HDL 38.3 mg/dl > 35 mg/dl LDL 162 mg/dl 1-180mg/dl Triglyceride 198 mg/dl 40-165 mg/dl AST 98 U/L 5-38 U/L ALT 94 U/L 5-42 U/L Fasting Blood Sugar 102 mg/dl 75-115 mg/dl July 4, 2012 Chemistry test Results Reference Values Creatinine 4.4 mg/dl 0.5-1.1 mg /dl Blood Urea Nitrogen 93.8 mg/dl 15-45 mg/dl Triglyceride 201 mg/dl 40-165 mg/dl Cholesterol 226 mg/dl < 200mg /dl Total Protein 16.3 g/dl 6.4-8.3 g/dl Albumin 6.3 g/dl 3.5-5.0 g/dl Albumin / G;obulin ratio 2.0 0.8-2.0 Potassium 5.86 mmol/L 3.6-5.0 mmol/L Sodium 148 mmol/L 134-146 mmol/L Chloride 99.7 mmol/L 96-107 mmol/L Magnesium 1.03 mmol/L 1.3-2.1 mmol/L August 9,2012 Chemistry test Results Reference Values Creatinine 5.01 mg/dL 0.5-1.1 mg /dl Blood Urea Nitrogen 105.3 mg/dL 15-45 mg/dl Potassium 3.01 3.6-5.0 mmol/L Sodium 148.3 134-146 mmol/L Chloride 110.1 96-107 mmol/L PSA: June 1, 2012 Positive 10ng (Reference Value < 4ng/dl )