35 yr old female
35 years old female , daily wage worker by occupation came presented with chief complaints of painful skin lesions on B/L upper and lower limbs since 2 months, fever and burning micturition since 4days.
Date of admission: 12/09/23
CHIEF COMPLAINTS
➤ Painful skin lesions over both hands and legs since 2 months .
➤Fever since 4 days
➤Burning micturition since 4 days
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 2 months back. Then she developed complaints of painful skin lesions over the arms and the legs , which was sudden in onset , progressive , no aggravating and relieving factors . Vesicles later ruptured with purulent discharge
Not associated with itching , fever and redness.
Fever since 4 days coming on alternate day not associated with chills and rigor, diurnal variation, relieves with medication.
Burning micturition since 4 days. Not associated with increased frequency /urgency /hesitancy/decreased urine .
H/o deformity of hands , toes and fingers since 16years which was sudden in onset and progressive after which she went to local doctor and took medication for the same but later stopped taking the medicines and carried on with her normal daily routine( as a daily wage worker) and deformity progressed.
no complaints of loss of function in either of the limbs.
No h/o breathless, palpitations, orthopnoea, PND, no known comorbidities.
PAST HISTORY
➤ No similar complaints in the past
➤ Not a k/c/o Diabetes mellitus , Hypertension, TB, epilepsy , asthma ,CAD , thyroid disorders , CVA.
➤ No history of blood transfusion.
➤ No surgical history .
PERSONAL HISTORY
➤Occupation: Daily wage worker
➤Patient is married .
➤Patient takes a mixed diet and has normal appetite.
➤Sleep : Regular
➤Bowel movements are regular ,
➤Bladder movement- Regular with burning micturition
➤No known allergies .
➤ No known addictions .
➤ Menstrual history
Age of menarche : 13 yrs
Cycle duration : 30 days of cycle
No of days of bleeding : 3 days
LMP : 23/08/23
➤ Obstetric history
Age at marriage : 18yrs
Age at 1st child birth : 18 yrs (FTND)
FAMILY HISTORY
Not significant .
GENERAL EXAMINATION
Patient is conscious ,coherent , cooperative ,
She is thin and undernourished.
Ht - 5 feet
Wt - 27 kg
Pallor : Seen
Pallor : Seen
Pallor : Seen
➤Icterus : Not seen
➤Cyanosis : not seen
➤Clubbing : not seen
➤Lymphadenopathy : not seen
➤Edema : not seen .
VITALS
➤ Afebrile
➤PR : 102 beats per minute
➤BP : 70/60 mm Hg
➤RR : 18 cycles per minute
➤SpO2 : 98% in room air
➤ GRBS : 104 mg/dl
SYSTEMIC EXAMINATION
JOINT FINDINGS
Pus cells : Plenty
RBC : 20-25cells
Casts : Nil
3. RFT
Blood urea : 37mg/dl
Serum Creatinine : 1.1mg/dl
Serum Na+ - 134meq/l
Serum K + - 3.3 meq/l
Serum Cl - - 97 meq/l
4. Serology
HCV - Negative
HBsAg - Negative
HIV - Negative
5. RBS - 89mg/dl
6. CRP - Positive (2.4mg/dl)
7. RPR - Non reactive
8. RA - Positive (24.10 IU/ml)
PROVISIONAL DIAGNOSIS: ? Cystitis IDA SECONDARY TO RHEUMATOID ARTHRITIS (? PYODERMA GANGRENOSUM)
TREATMENT
1. Tab. Nitrofurantoin 100mg PO/BD
2. Tab. Pantop 40 mg PO/OD
3. Tab. PCM 650mg PO/SOS
4. Syp Potchlor ml in 1 glass of water PO/TID
5. Fudic cream LA/BO
6. Inj. KCl 1 Amp in 500 ml NS over 4-6 hrs IV/STAT
7. Tab. Orofer XT PO/OD
8. Tab. Limcee PO/OD
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