Hyperpigmented lesions with alopecia

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 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 






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