from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable
)
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY

OUTPUT = "/home/daytona/workspace/differential-dx/Differential_Diagnosis_Rabeya_Begum.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle(
    "Title", parent=styles["Title"],
    fontSize=16, textColor=colors.HexColor("#1a3c5e"),
    spaceAfter=4
)
subtitle_style = ParagraphStyle(
    "Subtitle", parent=styles["Normal"],
    fontSize=11, textColor=colors.HexColor("#4a6e8a"),
    spaceAfter=10, alignment=TA_CENTER
)
h1_style = ParagraphStyle(
    "H1", parent=styles["Heading1"],
    fontSize=13, textColor=colors.HexColor("#1a3c5e"),
    spaceBefore=14, spaceAfter=4,
    borderPad=4
)
h2_style = ParagraphStyle(
    "H2", parent=styles["Heading2"],
    fontSize=11, textColor=colors.HexColor("#c0392b"),
    spaceBefore=10, spaceAfter=3
)
h3_style = ParagraphStyle(
    "H3", parent=styles["Heading3"],
    fontSize=10.5, textColor=colors.HexColor("#16a085"),
    spaceBefore=8, spaceAfter=2
)
body_style = ParagraphStyle(
    "Body", parent=styles["Normal"],
    fontSize=9.5, leading=14, spaceAfter=4,
    alignment=TA_JUSTIFY
)
bullet_style = ParagraphStyle(
    "Bullet", parent=styles["Normal"],
    fontSize=9.5, leading=13, leftIndent=14,
    bulletIndent=4, spaceAfter=2
)
small_style = ParagraphStyle(
    "Small", parent=styles["Normal"],
    fontSize=8.5, leading=12, textColor=colors.HexColor("#555555")
)
warning_style = ParagraphStyle(
    "Warning", parent=styles["Normal"],
    fontSize=9.5, leading=14, textColor=colors.HexColor("#7d1111"),
    backColor=colors.HexColor("#fff3f3"),
    borderPad=6, spaceAfter=6, spaceBefore=6,
    leftIndent=8, rightIndent=8
)

# Table styles
def section_table(header_color, data, col_widths):
    ts = TableStyle([
        ("BACKGROUND", (0,0), (-1,0), header_color),
        ("TEXTCOLOR", (0,0), (-1,0), colors.white),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTSIZE", (0,0), (-1,0), 9),
        ("FONTNAME", (0,1), (-1,-1), "Helvetica"),
        ("FONTSIZE", (0,1), (-1,-1), 8.5),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.white, colors.HexColor("#f0f4f8")]),
        ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#cccccc")),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
        ("TOPPADDING", (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("WORDWRAP", (0,0), (-1,-1), True),
    ])
    t = Table(data, colWidths=col_widths, repeatRows=1)
    t.setStyle(ts)
    return t

def bp(text):
    return Paragraph(f"• {text}", bullet_style)

def p(text, style=None):
    return Paragraph(text, style or body_style)

story = []

# ─── TITLE BLOCK ───────────────────────────────────────────────────────────────
story.append(Paragraph("Differential Diagnosis Report", title_style))
story.append(Paragraph("Patient: Rabeya Begum | Age: 71 Years | Sex: Female", subtitle_style))
story.append(Paragraph("BMU Hospital, Shahbag, Dhaka | Date: July 14, 2026", subtitle_style))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor("#1a3c5e"), spaceAfter=10))

# ─── PATIENT SUMMARY ──────────────────────────────────────────────────────────
story.append(Paragraph("1. Patient Summary & Clinical History", h1_style))

summary_data = [
    ["Domain", "Details"],
    ["Patient", "Rabeya Begum, 71F | Housewife | G6P6 (4 sons, 2 daughters) | All vaginal deliveries"],
    ["Comorbidities", "DM 20+ yrs (on insulin) | HTN 20+ yrs | H/O recurrent stroke (2 yrs back) | H/O recurrent dental infection"],
    ["Surgical Hx", "Bilateral salpingo-oophorectomy + cystectomy (2003) | Dental cystectomy (5 yrs back)"],
    ["February 2026", "Low-grade fever (few days) + abdominal pain + hemoptysis (several episodes, 1 day)\n→ Admitted Islami Bank Hospital: Rt-sided pneumonia with abscess diagnosed\n→ Shifted to NIDCH: Meropenem 14 days"],
    ["April 2026", "Rt facial deviation | Rt ear pain with pus | Slurring of speech\n→ ENT: Rt Bell's palsy + ASOM\n→ Neuro: Rt-sided ischemic stroke\n→ Imaging: Rt capsulo-ganglionic infarct; Bilateral maxillary & ethmoido-sphenoido-frontal sinus collection + mucosal thickening\n→ Readmitted: Moxibac + Meropenem 24 days | IV Albumin x3\n→ 2 weeks later: WBC 16,000 | Ear pain recurred → Moxiclav 10 days"],
    ["June 27, 2026", "Fever with chills and rigors\nWBC → 61,500 → 72,000 (extreme leukocytosis)\nUrine C/S: E. coli (sensitive to colistin, ceftazidime, fosfomycin)\nMeropenem started → changed to Efitaz + Linezolid\nConjunctival congestion developed (Lt > Rt)\nBone marrow biopsy deferred by hematologist (attributed to infection)"],
    ["Blood / Labs", "Hb 6.9 g/dL (Feb 2026) → 2 units RCC transfused | WBC 61,500–72,000 | Persistent leukocytosis"],
]
t = section_table(colors.HexColor("#1a3c5e"), summary_data, [3.5*cm, 13.5*cm])
story.append(t)
story.append(Spacer(1, 10))

# ─── PRIMARY DIAGNOSIS ────────────────────────────────────────────────────────
story.append(Paragraph("2. Primary Diagnosis (Most Likely)", h1_style))
story.append(Paragraph("Invasive Fungal Sinusitis — Mucormycosis / Invasive Aspergillosis with Intracranial & Systemic Extension", h2_style))

story.append(p("This is the most compelling unifying diagnosis. The entire multi-month clinical trajectory fits a single underlying condition:"))
story.append(bp("Poorly controlled DM (20+ years, on insulin) = classic host for angioinvasive fungi"))
story.append(bp("Bilateral pansinusitis (maxillary, ethmoidal, sphenoidal, frontal) confirmed on imaging"))
story.append(bp("Rt-sided ischemic stroke / capsulo-ganglionic infarct — caused by fungal vascular invasion of carotid siphon or deep perforators"))
story.append(bp("Rt facial palsy — likely fungal cranial nerve involvement (not idiopathic Bell's palsy)"))
story.append(bp("Rt ASOM with pus + ear pain — otologic spread of fungal infection"))
story.append(bp("Hemoptysis + lung abscess in February — pulmonary mucormycosis or Aspergillus"))
story.append(bp("Repeated failure of broad-spectrum antibacterials (meropenem, moxifloxacin) — primary pathogen is fungal, not bacterial"))
story.append(bp("Fever, extreme leukocytosis, hypoalbuminemia, anemia — immunocompromised state"))
story.append(Spacer(1, 6))
story.append(Paragraph(
    "⚠  KEY CLINICAL PEARL: Sinusitis + Stroke + Diabetes + Failed Antibiotics = Mucormycosis until proven otherwise. "
    "IV Liposomal Amphotericin B should be considered empirically pending biopsy. Delay significantly worsens mortality.",
    warning_style
))
story.append(Spacer(1, 8))

# ─── DIFFERENTIAL DIAGNOSES ───────────────────────────────────────────────────
story.append(Paragraph("3. Differential Diagnoses (In Order of Likelihood)", h1_style))

diffs = [
    (
        "1. Invasive Aspergillosis (Chronic Sinonasal + Pulmonary)",
        colors.HexColor("#c0392b"),
        [
            "Causes pansinusitis in diabetics and immunocompromised patients",
            "Can cause vascular invasion and cerebral infarction",
            "Pulmonary aspergillosis explains February hemoptysis and lung abscess",
            "More indolent than mucormycosis — fits this multi-month course",
            "Distinction from mucormycosis: culture/histology (septate vs. non-septate hyphae)",
        ]
    ),
    (
        "2. Septic Embolic Stroke from Infective Endocarditis (IE)",
        colors.HexColor("#e67e22"),
        [
            "Recurrent bacteremia sources: dental infections, prior abdominal surgeries (2003), UTI",
            "Rt capsulo-ganglionic infarct could represent septic embolism",
            "Fever, high WBC, multi-organ involvement (lung, brain, sinuses, ear)",
            "Conjunctival congestion could represent Roth spots or septic emboli",
            "Echocardiography (TTE/TEE) essential to rule in/out",
        ]
    ),
    (
        "3. Granulomatosis with Polyangiitis (GPA / Wegener's Granulomatosis)",
        colors.HexColor("#8e44ad"),
        [
            "Pansinusitis + pulmonary infiltrates/cavitation (abscess) + possible renal involvement",
            "Can cause cranial nerve palsies, orbital involvement, otologic disease",
            "Stroke can occur via CNS vasculitis (less common)",
            "c-ANCA / PR3-ANCA serology essential for diagnosis",
        ]
    ),
    (
        "4. Sinonasal Malignancy / NK-T Cell Lymphoma",
        colors.HexColor("#2980b9"),
        [
            "Bilateral pansinusitis in elderly with constitutional symptoms, anemia, weight loss",
            "NK/T-cell lymphoma (lethal midline granuloma): EBV-associated, destructive sinonasal disease, facial palsy",
            "WBC 61,500–72,000 raises concern for hematological malignancy",
            "Bone marrow biopsy was wisely considered — should be revisited if WBC persists",
            "Explains repeated antibacterial treatment failure",
        ]
    ),
    (
        "5. CSOM with Intracranial Complications",
        colors.HexColor("#27ae60"),
        [
            "Rt ASOM with pus → coalescent mastoiditis → lateral sinus thrombosis → stroke-like presentation",
            "Rt facial palsy: anatomically fits mastoid involvement of the facial nerve canal",
            "Sinusitis could be concurrent or secondary",
            "Does not fully explain hemoptysis, lung abscess, or extreme leukocytosis",
        ]
    ),
    (
        "6. Disseminated TB / Non-Tuberculous Mycobacteriosis (NTM)",
        colors.HexColor("#16a085"),
        [
            "Lung abscess + hemoptysis in South Asian patient = high TB suspicion",
            "Miliary TB can cause sinusitis, cerebral tuberculomas mimicking infarct",
            "Chronic anemia, hypoalbuminemia, poor response to standard antibacterials",
            "NTM (e.g., M. abscessus) increasingly seen in diabetics, very antibiotic resistant",
            "AFB smear/culture, CBNAAT (GeneXpert), IGRA essential",
        ]
    ),
    (
        "7. Leukemia (AML / CML) with Secondary Infections",
        colors.HexColor("#1a3c5e"),
        [
            "WBC 61,500–72,000 is extreme and cannot be dismissed as infection alone",
            "Leukostasis can cause CNS symptoms and stroke-like presentation",
            "Recurrent infections (dental, sinus, lung, urinary) suggest chronic immune dysfunction",
            "Anemia (Hb 6.9 g/dL) + high WBC + systemic illness = classic leukemia picture",
            "Bone marrow biopsy deferred — must be reconsidered urgently if WBC does not normalize",
        ]
    ),
    (
        "8. Bacterial Meningitis / Intracranial Abscess from Contiguous Spread",
        colors.HexColor("#7f8c8d"),
        [
            "Pansinusitis → direct extension via cribriform plate or thrombophlebitis → frontal lobe abscess",
            "Explains persistent fever, neurological deterioration, facial palsy",
            "Less consistent with capsulo-ganglionic stroke pattern (deep perforator territory)",
            "Sinogenic intracranial complications are well-recognized — contrast-enhanced MRI/CT essential",
        ]
    ),
]

for title, color, bullets in diffs:
    story.append(Paragraph(title, ParagraphStyle(
        "DiffH", parent=h3_style,
        textColor=color, spaceBefore=10, spaceAfter=3, fontSize=10.5
    )))
    for b in bullets:
        story.append(bp(b))

story.append(Spacer(1, 10))

# ─── SUMMARY TABLE ────────────────────────────────────────────────────────────
story.append(Paragraph("4. Summary Comparison Table", h1_style))

summary_table_data = [
    ["Diagnosis", "Supporting Features", "Against / Caveats"],
    ["Mucormycosis\n(PRIMARY)", "DM, pansinusitis, stroke, facial palsy,\nASOM, failed antibiotics, hypoalbuminemia", "No black eschar described\n(may be absent in early/deep disease)"],
    ["Invasive Aspergillosis", "Lung abscess, pansinusitis, DM,\nindolent multi-month course", "Less likely to cause ASOM;\nGalactomannan may help distinguish"],
    ["Infective Endocarditis", "Dental/sinus infection source, multi-organ,\nconjunctival signs", "E. coli rarely causes IE;\nneeds echo confirmation"],
    ["GPA (Wegener's)", "Sinusitis + lung + cranial nerve palsy", "Stroke pattern unusual;\nc-ANCA needed"],
    ["Sinonasal Lymphoma / Ca", "Refractory course, anemia, high WBC, elderly", "Hematologist deferred BM;\nneeds tissue biopsy"],
    ["CSOM + Intracranial Complication", "Rt ear pus, Rt facial palsy, sinusitis", "Does not explain hemoptysis\nor extreme leukocytosis"],
    ["TB / NTM", "Lung abscess, hemoptysis, South Asian,\nDM, poor antibiotic response", "No AFB workup documented yet;\nshould be pursued urgently"],
    ["Leukemia (AML/CML)", "WBC 61–72K, anemia, recurrent infections", "Hematologist attributed to infection;\nBM biopsy needed"],
]
t2 = section_table(colors.HexColor("#1a3c5e"), summary_table_data, [4*cm, 7*cm, 6*cm])
story.append(t2)
story.append(Spacer(1, 10))

# ─── INVESTIGATION PRIORITIES ─────────────────────────────────────────────────
story.append(Paragraph("5. Recommended Investigations (Priority Order)", h1_style))

inv_data = [
    ["Priority", "Investigation", "Rationale"],
    ["URGENT", "MRI Brain + PNS with contrast\n(or CT with bone windows)", "Characterize sinusitis extent, infarct pattern,\nbony erosion (mucormycosis), intracranial complications"],
    ["URGENT", "Nasal endoscopy + sinus biopsy\n(GMS stain, culture)", "Histology/culture for fungal hyphae — essential for\nmucormycosis vs. Aspergillus diagnosis"],
    ["URGENT", "Peripheral blood film + bone marrow biopsy", "Rule out leukemia/lymphoma given extreme WBC"],
    ["HIGH", "Serum galactomannan + beta-D-glucan", "Aspergillus markers (galactomannan negative in mucor)"],
    ["HIGH", "Mucormycosis PCR from sinus biopsy", "Molecular confirmation"],
    ["HIGH", "HbA1c + fasting glucose + ketones", "DKA / poor glycemic control = highest mucormycosis risk"],
    ["HIGH", "ANCA (c-ANCA/PR3, p-ANCA/MPO)", "Rule out GPA (Wegener's)"],
    ["HIGH", "Blood cultures x3 (aerobic + anaerobic)\n+ Echocardiography (TTE/TEE)", "IE workup — vegetations"],
    ["HIGH", "AFB smear + culture + CBNAAT (sputum/BAL)", "TB / NTM workup"],
    ["MODERATE", "CT Chest", "Characterize pulmonary lesion (cavity, nodule, abscess)"],
    ["MODERATE", "Urine C/S (repeat) + renal function", "E. coli UTI source control; renal status before Ampho B"],
    ["MODERATE", "LDH, ferritin, CRP, ESR, albumin", "Inflammatory burden, nutritional status, lymphoma markers"],
]
t3 = section_table(colors.HexColor("#1a3c5e"), inv_data, [2.5*cm, 6.5*cm, 8*cm])
story.append(t3)
story.append(Spacer(1, 10))

# ─── MANAGEMENT NOTE ──────────────────────────────────────────────────────────
story.append(Paragraph("6. Urgent Management Note", h1_style))
story.append(Paragraph(
    "⚠  EMPIRICAL ANTIFUNGAL THERAPY: If clinical suspicion for mucormycosis is high, do NOT wait for culture confirmation. "
    "Start IV Liposomal Amphotericin B (5–10 mg/kg/day) immediately. Mortality rises sharply with every day of delay. "
    "Surgical debridement of necrotic sinus tissue is often necessary in addition to antifungals.",
    warning_style
))
story.append(bp("Optimize glycemic control aggressively (target HbA1c; treat DKA if present)"))
story.append(bp("Discontinue deferoxamine if used (increases mucormycosis risk)"))
story.append(bp("Antifungal step-down to Posaconazole or Isavuconazole after clinical stabilization"))
story.append(bp("Neurology review for ongoing stroke management and secondary prevention"))
story.append(bp("Hematology review — bone marrow biopsy should not be deferred further if WBC remains >50,000"))
story.append(bp("ENT surgical review for endoscopic debridement"))
story.append(bp("Nutritional support: IV albumin, dietitian referral"))
story.append(Spacer(1, 10))

# ─── FOOTER ───────────────────────────────────────────────────────────────────
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor("#cccccc"), spaceBefore=10))
story.append(p(
    "<i>This report is generated for clinical reference purposes. All diagnoses must be confirmed by appropriate "
    "investigations and clinical judgment. Prepared: July 14, 2026 — BMU Hospital, Dhaka.</i>",
    small_style
))

doc.build(story)
print(f"PDF created: {OUTPUT}")