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)

Popular posts from this blog

CBBLE UDHC SIMILAR CASES This is an 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 community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

Image
PULMONOLOGY BLOG RICU admission  Bed 3  68 y old male , Pt came with the chief complaints of breathlessness since 4 months, Rt sided chest pain since 5days HOPI :  Pt was apparently asymptomatic 4yrs back then developed breathlessness which was insidious in onset, gradually progressed from MMRC grade I to grade II.  Breathlessness aggrevated during exertion and relieved on taking rest. No positional variation , not associated with wheeze, orthopnea present. Pt c/o Rt sided chest pain since 5 days, insidious in onset, dragging type of pain , non radiating. No c/o cough , chest pain, chest tightness,  haemoptysis. No fever spikes.  PAST HISTORY:  H/O Similar Complaints in the Past 2yrs back and started using inhaler since 2yrs. Past H/O TB 20yrs back, used ATT for 6 months N/K/C/O  DM, HTN, CAD, EPILEPSY.  PERSONAL HISTORY:  Diet : normal  Appetite : normal  Bowel and bladder movements : normal No known allergies  Chronic smoker for 20 years - 1 beedi pack/ day Stopped since 10years FAMI
Read more

PARAPERISIS-1

Image
"I've been given this case   https://srianugna.blogspot.com/2020/05/hello-everyone.html l https://youtu.be/3VVH7w3rWSM  to solve in an attempt to understand the topic of "paraparesis." This may develop my competency in a) reading and comprehending clinical data related to "paraparesis" including history, clinical findings, investigations b) come up with a diagnosis such as: 1) Anatomical location of the root cause 2) Physiological functional disability 3) Biochemical abnormalities that could be a root cause at a molecular level 4) Pathology that could reflect the root cause at a cellular level c) a treatment plan for each of these patients of paraparesis that can have a pharmacological and non pharmacological component. d) learning the scientific basis of diagnostic and therapeutic approach in terms of past collective experiences and experiments (aka evidence based medicine). Following is my analysis of patient's problem. Patient is 18 year old came wit
Read more

25 year old male patient with alcohol dependence syndrome

Image
A 25 year old male , daily labour by occupation ,came to the OPD with cheif complaints of - Head injury since seven days  associated with vomitings, complains of tremors since 2days History of presenting illness - patient was apparently asymptomatic 7 days  back then he had head injury (under the influence of alcohol) associated with vomiting since 7days back -1 episode/day projectile,contents-food , tremors developed after stopping alcohol consumption from 2 days Past history -  Pateint ia an alcoholic since 1 year which was consumed occassionally then he increased consumption since 3 months because of personal family issues then stopped alcohol consuption from 4 days  not a known case of htn , dm ,  epilepsy , asthma , tb no previous surgical history  no history of gallstones in the past Personal history : Diet - mixed ,appetite -decrease appetite ,bowel movement - regular,  bladder movements - regular  , addictions(alcohol) -  alcoholics in 1 year takes at least 750ml occasional con
Read more