Biographical Data:  Name: QASSEM  Gender: Male  Age: 32 years  Nationality: SAUDI  Marital status: married with no children

 Occupation: Taxi driver Chief Complaint : Back pain for 4 months Generalized weakness with fever and shortness of breath for 2 weeks istory of Present illness : Mr. Qassem is a 32 years Saudi male known case of decreased G6PD activity frist seen on the A/E department , at that time he presented with severe continuous lower back pain started 4 months ago with no radiation to the legs nor any where. it was aggravated by movements not relieved by analgesics and massaging which he tried . The pain was not associated with urinary incontinence or other neurological symptoms . At that time he had dyspnea along with fever and generalized body weakness for 2 weeks . the fever was mainly at night along with night sweats , he went to health center where it was recorded 38.5 , without chills or rigors . he didn't try any thing to relieve it . shortness of breath was with minimal exertion without orthopnea or nocturnal paroxysmal dyspnea . it was associated with productive cough of

small amount of greenish sputum not streaked with blood .

N/H/O chest pain , pleurisy , abdominal pain , confusion , blurred vision bowel changes, headache , vomiting or weight loss . He was advised for a bone marrow biopsy he refused and went to Jordan for another opinion . At JORDAN a BONE MARROW BIOPSY was done and a diagnosis of ACUTE B- CELL LYMPPHCYTIC LEUKEMIA was made . he came back to Bahrain to receive treatment . further investigations including heart ECHO and BONE MARROW slides were reviewed and confirmed the diagnosis ACUTE B- CELL LYMPPHCYTIC LEUKEMIA . He was treatmted with 4 courses of CHEMOTHERAPY , after the 2nd course BONE MARROW BIOPSY was done and confirmed disease remission . he tolerated chemotherapy very well , although fever , neutropenia and anemia which required blood transfusion . The time reviewed he had no symptoms related to chemotherapy .

Past history of present illness : Didn't experience this before .

History of Past illness : Immunization : Took them all . Medical Illness : 1. decreased G6PD activity . has no history of DM , hypertension, hyperlipidemia or SCD .

Medications :
Apart of chemotherapy treatment not taking any treatment

Operations :

None

blood transfusion:
6 months ago for his low hemoglobin levels . N/H/O trauma, accidents, OR allergies.

Family History: N/H/O malignancies , DM, hypertension or hyperlipidemia . +VE family history of decreased G6PD activity .

Psychosocial History : Qassem Jaafar is married since 2001 with no children . he lives in his own house in madeenat hamad consists of 3 bedrooms , 3 toilets an a kitchen . he is a driver . The income is appropriate . He used to smoke 1 pack aday during the last 18 years but he quit last year . he doesn't drink alcohol . Concerning diet, he eats everything which is homemade most of the time . Hobbies : car games . Systems Review :

1) General: generalised weakness. 2) Skin: - NO yellowish discoloration of face, trunk and abdomen. 3) Eyes: normal . 4) Respiratory system
Dyspnea & productive cough . - No history of chest pain or tightness 5) Cardiovascular system - No palpitations

- No history of dyspnea or paroxysmal nocturnal dysppnea. 6) Endocrine system N/H/O polydepsia, polyuria or loss of weight. 7) GI system - N/H/O abdominal pain with no vomiting or nausea. - No history of diarrhea, constipation or heart burn. 8) Urinary system - NO history of dysuria & polyuria .

9) Nervous system
No history of headache, seizures or loss of sensations.

Physical Examination

General assessment:
QASSEM was lying comfortably on a bed, conscious , alert , oriented in pain , mild painless not cyanosed or jaundiced . Vital signs: 1) Temperature: 38.5 oC 2) Respiratory Rate: 23 /min 3) Pulse: 121/min, symmetrical, regular rhythm, normal volume and character. 4) Blood Pressure: 124/66 mmHg

General Examination

1) Respiratory system
y Inspection: Normal chest shape, symmetrical with

abdominothoracic breathing. y Palpation: central trachea, equal chest expansion on both sides, symmetric vibration on tactile fremitus. y y Percussion: resonant lung. Auscultation: Normal vesicular breathing over the lungs, equal air entry bilaterally, no added sounds.

2) Cardiovascular system
y y Inspection: No scars, No distended veins. Palpation: apex beat in the 5th intercostal space at midclavicular line, No heave or thrills. y Auscultation: Normal 1st and 2nd heart sounds, no murmurs were heard.

3) Nervous system
y Motor system:  Normal muscle tone.  No wasting or fasciculation.  Normal muscle power of upper and lower limbs.  Normal tendon reflexes.

Normal

sensations

of

light

touch,

pain,

vibration

and

proprioception.

ABDOMINAL EXAMINATION : y Inspection:

o The abdomen was symmetric and flat with normal hair distribution. o There were no rashes, visible veins or striae o The umbilicus was normal central and inverted with no hernia. o -VE cough impulse, reducible hernias. o There was no visible peristalsis or pulsations on the abdomen.

y Auscultation:
o Normal bowel sounds, gurgling in character. o Normal circulatory sound, no bruits are heard over aorta or renal arteries.

y Palpation:
o NOT tender .

o - VE Murphy's sign. o McBurneys sign was VE. o hepatomegaly o spleenomegaly 5-6 cm below LCM . o No masses were felt.

Percussion:
o Tympanic note over most of the abdomen except the liver and spleen. o Liver was normal (dull). The liver span was approximately 18 cm at o MCL. o Spleen 5-6 cm below LCM .