1601006085 SHORT CASE

 HALL TICKET : 1601006085


SHORT CASE ELOG
This is an online E log book to discuss patient's de-identified health data shared after taking his/her/guardian's signed informed consent.

A CASE OF RECURRENT MULTIPLE SKIN ERUPTIONS

A 23 year old lady,Psychologist by Occupation, resident of Nalgonda Came to the OPD with

Chief complaints of - Multiple small Painful red colored skin eruptions over the upper and lower limbs and back of the trunk since 8 months

HISTORY OF PRESENT ILLNESS : 

Patient was apparently asymptomatic 8 months ago and then she developed multiple small red Palpable eruptions on both lower limbs which were not associated with Burning or itching sensation . After 1 week She developed Occasional Burning over the lesions. She consulted a local dermatologist where she was prescribed antihistamines and was asked to avoid oily foods and vit. C and the lesions didn't subside. So she was referred to another Hospital where she was diagnosed with HENOCH SCHONLEIN PURPURA .
GENERAL PHYSICAL EXAMINATION :

Patient is conscious, coherent,cooperative and moderately built and moderately nourished 

NO Pallor, Icterus, Cyanosis, clubbing, Odema, lymphadenopathy.


Vitals: 

→ patient is afebrile

→ BP-110/80 mm Hg

→ PR-70 bpm

→ RR-16 Cpm

✓SpO2- 98%

✓GRBS - 122gm/dl

Local Examination - 

RED erythematous lesions Over Hands, legs, Palms and Soles including Web Spaces

CNS Examination

Higher mental functions-normal 
Cranial nerves- intact
Sensory system- normal
Motor system- normal 
Meningeal signs- absent 
Cerebellar signs- absent

CVS Examination

S1 and S2 heard , No murmurs heard

Respiratory system examination

Normal Vesicular Breath sounds heard

No added sounds

Abdominal examination

Inspection- 

Shape : elliptical 

Umbilicus - central and inverted

No scars,sinuses or engorged veins 

Palpation:

No tenderness , No organomegaly

Percussion: Tympanic

Auscultation: Normal 

Investigation :





















PROVISIONAL DIAGNOSIS - HENOCH SCHONLEIN PURPURA

Treatment 

Patient is on medications

Tab. Dapsone 100mg
Syrup orofer 5ml
Tab. Shelcal











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