Hyperpigmented lesions with alopecia

-

 This is an E log book to discuss our patients de identified health data shared after guardians informed consent.

Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve this patients clinical problems with collective current best evidence based inputs.

This E-book also reflects my patients centered online learning portfolio and your valuable comments in comment box are most welcome.

Details of patient when admitted 2 months back in a health centre in the below link:


https://rhea9895.blogspot.com/2022/01/29-years-old-female-with-co-joint-pains.html

Reference of this blog: Reference:https://nikitha0510.blogspot.com/2022/03/dermatomyositis.html?m=1)

I have been given this case to solve in an attempt to understand the topic of "patient clinical analysis" to develop my competency and to comprehend clinical data including history, clinical finding investigations and come up with a diagnosis and treatment plan.


Chief complaints:

Fever since 4 days 

B/L joint pains associated with pedal oedema since 4 days 

Dyspnoea since 3 days 



HISTORY OF PRESENTING ILLNESS


Patient was apparently asymptomatic 12 months ago. 

 Then she developed symmetrical b/l joint pains in the knees which was insidious in on set, gradually progressive, no aggravating factors and relieved on medication

she developed itching over neck and upper chest area and due to over it hing at the location it turned black.






(Reference:https://nikitha0510.blogspot.com/2022/03/dermatomyositis.html?m=1)

 Alopecia since 12 months associated with pain,

Also had malar rash  became hyperpigmented.

 vaginal discharge since 10 months. It was initially curdy white which later changed to watery discharge

Difficulty in walking.distal muscle weakness

She also had difficulty in breathing at rest since 3 days.which was gradually progressing

. She also complained of pins and needles sensation in the palms and thighs.

.

PAST HISTORY


No H/O DM, HTN, asthma, epilepsy, CAD


Personal history:

Diet ;mixed 

Sleep adequate

Bowel,bladder  habits regular.

Addictions none.


 

Menstrual history:

Menarche: 11 year

Cycle lasts: 26-28 days

3 days of menstruation

Regular cycles

She also had vaginal discharge. 

No pains or clots:

MARITAL HISTORY


She is married but doesn't have any kids, she has adopted a girl from her sister in law



GENERAL EXAMINATION 


The patient was conscious, coherent, cooperative, well oriented to time, place, person. She was moderately built and moderately nourished

Pallor: Present


No icterus, cyanosis, clubbing, lymphadenopathy 

Pedal edema: present 

VITALS: 

Temperature: afebrile.

BP: 150/100 mm Hg

PR: 114 bpm

RR: 30 cpm

SYSTEMIC EXAMINATION


CVS - S1, S2 hear

RS: BAE +

P/A: soft, non tender

CNS: NA

Investigation:



They performed a ANTI NUCLEAR ANTIBODY immunofluorescence which showed

Homogeneous pattern. Intensity 4+ the assosiated antigens involved are: dsDNA, Histones.


They also performed an HRCT which showe

: few patchy areas of ground glass opacities in peri bronchovascular distribution- s/o pneumonitis 



PPROVISIONAL DIAGNOSIS 

Dermatomyositis



TREATMENT:

1.T.SEPTRAN DS TID 


2.TAB.FLUCONAZOLE 150 MG OD 


3.OINT.CANDID.


4.TAB.WYSOLONT 50 MG OD 


5.TAB.FOLIC ACID 5 MG ONCE A WEEK.


Images after 2 months of treatment:



Follow up 











Day 5 fever chart showed up the spikes 






Comments

Post a Comment

Popular posts from this blog

MY VOYAGE IN MEDICINE DEPARTMENT

-
Image
Hello and welcome! This is Navyatha Pothula currently doing my internship.  A s the curtain falls on this chapter of my life, I reflect with gratitude and sentiment on the profound journey through the corridors of the medicine department. In this blog, I express my appreciation for the lessons learned, the connections forged, and the growth experienced during my time in this transformative field. Before I embark on the next phase of my career,  I want to express my sincere gratitude to the faculty, mentors, colleagues, and patients who have been integral to my medical journey. Their guidance, support, and shared experiences have been invaluable pillars, shaping not only my professional identity but also my personal growth.   Journey: My first interaction in medicine department was in my 5th semester where in I was brought together with my pgs and seniors and many of my classmates in a lecture hall where we discussed cases posted in our department with wide r ange of topics and persp
Read more

General Medicine Internship Real Patient OSCEs

-
Image
Introduction:   This  online  E-log Entry Blog  is an  objectively structured clinical examination method to assess the clinical competence during the course of my General Medicine Internship rotation (October '2023-November 2023) by reviewing the case reports shared below and  to discuss, understand and review the clinical scenarios and data analysis of patients so as to develop my clinical competency in comprehending clinical cases, and providing evidence-based inputs for questions surrounding the clinical vignettes borrowed from the E Log Book. Note:  The cases have been shared after taking consent from the patient/guardian. All  names and other identifiers have been removed to secure and respect the privacy of the patient and the family. This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online
Read more

Evidence of workflow done during internship rotation!

-
Image
Hello everyone This is Navyatha! This is a compailation of work blogs and PAJR created during my medicine rotation! Life in medicine department is a delicate balance—between patient care and paperwork, professional responsibilities and personal well-being. The lesson lies in mastering this equilibrium, knowing when to push forward and when to pause, ensuring sustained excellence in both professional and personal realms. Case 1: https://navyathapothularollno110.blogspot.com/2023/10/this-is-online-e-log-book-to-discuss.html Chief complaints : Patient came with chief complaints of fever since 10 days HOPI Patient was apparently asymptomatic 10 days back and developed fever which is intermittent  high grade relieved on medication  Associated with chills and rigor  Loss of appetite Not a/s w cold cough  Not a/s chest pain ,palpitations,shortness of breath  Past history: H/o surgery: umbilical hernia : hernioplasty 30 yrs ago  Not a k/c/o Dm Htn tb asthma  Personal history: Appetite:decrea
Read more