1601006170 SHORT CASE

 

SHORT CASE - 1601006170

Short case - 1601006170

A 23 year old lady , psychologist by occupation resident of nalgonda came to opd with c/c of painful skin leisions over the upper and lower limbs and back of trunk since 8 months 

HOPI:
Patient was apparently assymptomatic 8 months back then she developed multiple red lesions on both lower limbs not associated with burning or itching after 1 week she developed itching and burning sensation.

History of Joint pains initially in the left wrist later Progressed to left elbow .

History of abdominal pain present. 

She consulted local doctors who prescribed some medications but leisions didn't subsided so she referred to another hospital Where she diagnosed HENOCH SCHOLEIN PURPURA

She was asked for  CUE, ASO TITRE, ESR, RFT,Serum Bilirubin which was normal and diascopy showed Non blanchable palpable erythamatous Purpura 

Examination : 

general physical examination:

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

Vitals: 

patient is afebrile

BP-110/80 mm Hg 

PR-70 bpm 

RR-16 Cpm

SpO2- 98%

GRBS - 122gm/dl

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

INSPECTION

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: 

Inspection :

No scars sinuses and engorged ve

No visible pulsation

Palpation:

apical impulse : heard in fifth inter coastal spac

Auscultation:

S1 and S2 heard

No murmurs heard


Respiratory system examination:

Inspection of upper respiratory system- 

oral cavity- normal

Nose- normal 

Pharynx- normal 

Lower Respiratory Tract:

Inspection: 

trachea: central 

Symmetry of chest : symmetrical 

Movement: B/L symmetrical expansion of chest respiration

No scars, engorged veins or sinuses.

Palpation:

All inspectory findings are confirmed by palpation.

Trachea: central - confirmed by three finger test.

Assessment of anterior and posterior chest expansion- B/L symmetrical expansion of chest.

No chest wall tenderness 

Vocal fremitus- normal

Percussion : 

done in sitting position 

Resonant

Auscultation: 

Vesicular breath sounds heard

Bilateral air entry present

No added sounds

*Abdominal examination:

Inspection:

Shape : elliptical 

Quadrants of abdomen moving in accordance with respiration.

Umbilicus- central and inverted

No scars sinuses or engorged veins 

Palpation:

No tenderness 

No organomegaly

Percussion:

tympanic 

Auscultation:

Normal 

No organomegaly , no tenderness.

Investigations reports:

Haemogram showed normochromic normocytic Blood Picture with Neutrophilic leucocytosis 








PROVISIONAL DIAGNOSIS- HENOCH SCHONLEIN PURPURA ( Leucocytoclastic Vasculitis)

TREATMENT: 

At present patient is using:

Tab. Dapsone 100mgS

Syrup orofer 5mlT

Tab Shelcal





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