48 year old female with multiple system involvement
internal medicine post graduation
48 YEAR OLD WOMEN WITH MULTI-SYSTEM INVOLVEMENT.
CBBLE UDHC SIMILAR CASES
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48 year old female , resident of Hyderabad and home -maker by occupation, presented to casualty on 14/3/22 with complaints of ,
shortness of breath since 1 week - initially grade -2 later progressed to grade 4 .
pedal edema and chest tightness
generalised weakness and fatigue and frequent falls
difficulty opening mouth and oral ulcers since 1 week.
difficulty in swallowing both solids and liquids since 3 days .
H/O skin peeling all over body 25 DAYS ago .
TIMELINE :
25-01-2022
SPUTUM CBNAAT REPORT - OUTSIDE HOSPITAL.
REPEAT SPUTUM AFB OUT HOSPITAL REPORT :
( 19/03/22)
PERSONAL HISTORY :
loss of appetite
weight loss present
sleep adequate
bowel and bladder movements regular
C/O burning micturation since 1 week
GENERAL EXAMINATION :
PT C/C/C
PALLOR - PRESENT
NO ICTERUS ,CYANOSIS ,CLUBBING ,LYMPHADENOPATHY
MILD EDEMA - NON PITTING EXTENDING UPTO FEET .
VITALS ON ADMISSION :
Vitals at the time of admission:
Temperature:100F
PR: 98bpm
BP:130/80mm Hg
RR:27cpm
Spo2: 95%
GRBS:105gm%
HEAD TO TOE EXAMINATION :
ALOPECIA- PRESENT.
EYES - Proptosis Seen . NO conjunctival suffusion
EOM- intact
MICROSTOMIA PRESENT
BALD TONGUE NOTED , RED COLOR
no ulcers .
THYROID- no goitre noted
SKIN -
MULTIPLE HYPER- PIGMENTED MACULES SEEN ALL OVER FACE, UPPER LIMBS , NECK ,THIGH , ABDOMEN AND UPPER BACK .
DRY SKIN PRESENT
THICKENING OF SKIN over fore arms , dorsum of hand and fingers and on around mouth.
absent hair
SLIGHT PEELING still over arms and legs .
SYSTEMIC EXAMINATION :
RESPIRATORY SYSTEM :
Inspection :
Movements of chest appears to be Equal on both sides .
Palpation vocal fremitus decreased in left mamary , ISA area
Percussion
Dull note in left mamary area and ISA .
Auscultation :
- Decreased air entry on left ISA,IMA .
RIGHT side - normal air entry .
-BILATERAL VESICULAR BREATHING NOTED .
-Tubular breathing heard on right inter-scapular area .
-Coarse crepitations - end inspiratory - no variation with cough - heard on left ISA >>right ISA .
CARDIO VASCULAR SYSTEM :
S1S2 heard.
No murmurs. No palpable heart sounds.
PER ABDOMEN -
SOFT , NO ORGANOMEGALY.
NO GUARDING AND RIGIDITY.
BOWEL SOUNDS PRESENT .
CNS :
NO FOCAL NEUROLOGICAL DEFICITS .
GAIT - NORMAL
RHOMBERGS NEGATIVE .
PROVISIONAL DIAGNOSIS :
ERYTHRODERMA SECONDARY TO ATT - RESOLVED .
SYSTEMIC SCLEROSIS
K/c/o HTN , HYPOTHYROIDISM
ON PRESENTATION :
ON 21/3/22 :
RBS: 70mg/dl
HbA1c : 6.8%
RFT
Blood Urea: 136mg/dl
S. Creatinine: 4.8mg/dl
Na 139
K 3.0
Cl 102
Hemogram
HB 7.2
TC 15,000
MCV 80.4
PCV 21.5
MCH 27.0
MCHC 33.6
PLT 3.67
RDW 62
P.S NORMOCYTIC, NORMOCHROMIC
Serum iron : 45ug/dl
ABG
pH 7.34
PCo2 18.8
PaO2 92.4
HCO3 12.2
SpO2 96
LFT
TB 2.8
DB 0.74
AST 14
ALT 10
ALP 673
TP 7.4
ALB 2.23
CUE
ALB ++
Sugars nil
Pus cells plenty
Epithelial cells 1-2
COVID-19 RAT - NEGATIVE
ESR - 180
CRP - POSITIVE (1.2 mg/dl)
RA FACTOR - NEGATIVE .
LDH - 326 IU/L
Chest X-ray
ECG
USG ABDOMEN
HRCT
Few small volume mediastinal lymph nodes noted
Both lungs are studded with tiny nodular densities -
Small air filled cyst noted left lower lobe.
No evidence of effusion.
Non-obstructive left renal calculus.
Diagnosis: military tuberculosis,Antitubercular therapy induced scleroderma
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