1601006196 SHORT CASE

1601006196 SHORT CASE

This is a seemingly interesting case of a 22year old male who came with complaints of distension of abdomen and facial puffiness since 8 months. If my memory served me right I could only think of Cushing’s syndrome but I found it cryptic as to what might have been the cause with no known history of oral steroids. So, here goes my pursuit of finding the genesis of the disease.

HISTORY OF PRESENTING ILLNESS:

The patient was asymptomatic 1.5 years back then he developed red itchy ring like lesions over his thighs for which he heedlessly though intermittently applied over the counter clobeta GM for 7 months. He also took an ayurvedic syrup but all his efforts went in vain when he again started to notice a significant increase in his lesions and this time with an unusual increase in his weight from 50 to 70kgs in October 2019. 


The patient denied any kind of oral steriod usage which was a key point. He had no history of constipation or loose stools, fever, cough, abdominal pain, no history of hair loss or thining.

No h/o of hypertension, DM, thyroid, coronary artery disease, epilepsy and no h/o of body pains and delayed wound healing and no h/o of pedal edema emotional lability anorexia, easy fatiguability, no h/o of decreased vision , no h/o weakness, no h/o acne.

PERSONAL HISTORY 

The patient is having a good appetite and mixed diet adequate sleep and bladder movements regular and he does not smoke or drink alcohol.

GENERAL EXAMINATION:

The patient is conscious coherent cooperative, has an obese build and moderately nourished.

He has no pallor, icterus, cyanosis, clubbing, lymphadenopathy and pedal edema.

He had a distended abdomen with purple striae



Facial puffiness was present

BP 120/80

Pulse 82bpm and regular

Temp- afebrile

RR- 20/min

 SYSTEMIC EXAMINATION:

CVS: 
S1 S2 heard , no murmurs.

RESPIRATORY SYSTEM:

Bilateral air entry present , normal vesicular breath sounds heard.

PER ABDOMEN:
 soft non tender distenstion of abdomen present.

CNS: no abnormality detected.



INVESTIGATIONS:



Diagnosis: Exogenous topical steroid induced Cushings syndrome 


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