30 year old female with ENL

CC -30 year old female came to casuality with c/o painful lesions along the body since 1 year

HOPI- Patient was apparently asymptomatic 1year back then she observed pain initially over skin of left leg following which she noticed a small nodular lesion initially small with reddish discoloration but progressively grown and felt localized rise in temperature which over days healed with hyperpigmented rashes. Intially she used ayurvedic medicine for few months even then the lesions didnot subside completely. 6 months back she doveloped similar non itchy lesions over both hands extending proximally and healed with hyperpigmented rash.
Pain-Nodules-burning sensation-heals with hyperpigmentation.

PAST HISTORY-Since 8 months she doveloped similar lesions on face and from 1 and half to 2 months she doveloped similar lesions on ears etc currently not healed.
N/K/C/O DM, HTN, TB, ASTHAMA

PERSONAL HISTORY-
Mixed diet
appetite -normal 
bowel and bladder - Normal
no addiction 
No known allergies

FAMILY HISTORY - not significant 

PHYSICAL EXAMINATION-
no pallor, icterus, cyanosis, clubbing, lymphadenopathy, oedema, dehydration 

VITALS-
temperature - afebrile 
pulse rate - 82 bpm 
RR - 18 cpm 
BP - 130/80 mm hg 
SPO2 - 98 on RA 
GRBS - 117.mg %

SYSTEMIC EXAMINATION-
CVS-S1 ,S2 heard ,no murmurs 
RS -BAE +, NVBS
 P/A - soft ,non tender 
CNS -
speech - normal 
 power 
U.L - 5/5 
L.L - 5/5
TONE - normal 
REFLEXES 
KNEE - + 
BICEP - + 
TRICEP-+
ANKLE - + 
BRACHIORADIALIS - + 
PLANTAR - withdrawal

PROVISIONAL DIAGNOSIS-
ERYTHEMA NODOSUM LEPROSUM (CUTANEOUS VASCULITIS)

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