Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of...
Transcript of Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of...
![Page 1: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/1.jpg)
Case presentation
Dr Rammohan Reddy 1st year PG, Dept of DVL,
Kamineni Institute of Medical Sciences,
Narketpally.
![Page 2: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/2.jpg)
• Name : XXX
• Age : 33 years
• Sex : Female
• Occupation : Farmer
• IP no : 201608905
• DOA : 15-02-2016
• Marital Status : Married
![Page 3: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/3.jpg)
Case History
A 33 year old female farmer came with complaint of multiple, red colored, raised skin lesions associated with itching and burning on exposed parts of the body since 8 years.
![Page 4: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/4.jpg)
History of present illness:
Patient was apparently asymptomatic 8 years back. She gives history of coin shaped lesions which started initially as red colored lesions on both cheeks which gradually increased in number and reached present size in 6 months.
![Page 5: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/5.jpg)
• Similar red colored, scaly, raised lesions appeared on bridge of nose, forehead, around mouth and on ears, exposed parts of hands, front of the neck, upper chest, upper back and right leg after 1 month.
• These small lesions coalesced to form present sized lesions over 6 months.
![Page 6: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/6.jpg)
![Page 7: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/7.jpg)
• H/o photosensitivity.
• No h/o oral ulcers.
• No h/o fever, fatigue.
• No h/o joint pains, stiffness, swelling.
• No h/o discoloration of fingers upon exposure to cold.
• No h/o weight loss.
![Page 8: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/8.jpg)
• No h/o Shortness of breath, chest pain.
• No h/o headache, confusion or memory loss.
• No h/o drug intake prior to onset of these symptoms.
• No h/o dysphagia, tightening of skin.
• No h/o dry eyes and dry mouth.
![Page 9: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/9.jpg)
• No h/o proximal muscle weakness.
• No h/o high colored urine / hematuria.
• No h/o abdominal pain.
![Page 10: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/10.jpg)
Past history: Not a known case of Hypertension, Diabetes, Pulmonary Tuberculosis, Asthma, Epilepsy.
Family history: no h/o similar skin lesions in family.
Menstrual/obstretic –
5/30 regular, G3P3L3.
![Page 11: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/11.jpg)
Personal history
• Diet : mixed
• Appetite : normal
• Sleep : adequate
• Bowel and bladder : regular
• Addictions : nil
![Page 12: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/12.jpg)
Drug history
No h/o known allergies to drugs.
Patient used both topical and oral medications from local doctor on and off since 8 years (no documents available) with mild improvement to recur again.
![Page 13: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/13.jpg)
General Examination
Patient is conscious, coherent, co operative, moderately built , moderately nourished.
No Pallor
No Icterus
No Cyanosis
No Generalised Lymphadenopathy
No Pedal edema
![Page 14: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/14.jpg)
Vitals:
Temperature= 98.6O F
Pulse Rate= 72/minute, regular, normal volume and other peripheral pulses felt.
Blood Pressure= 110/70 mm of Hg.
Respiratory Rate= 20/ minute
![Page 15: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/15.jpg)
Systemic Examination
• Cardio Vascular System : S1, S2 heard, no murmurs.
• Respiratory System : bilateral air entry- present, normal vesicular breath sounds, no added sounds.
• Central Nerve System : higher mental function normal. No other abnormalities are detected.
• Abdomen : soft, non tender, no organomegaly, bowel sounds heard.
![Page 16: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/16.jpg)
Cutaneous Examination
![Page 17: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/17.jpg)
Multiple, well defined, erythematous plaques ranging in size 2-15cm with adherent scales and hyperpigmented borders, distributed bilaterally symmetrical on face including bridge of nose, vermilion border of both upper and lower lips.
Carpet tack sign – positive.
![Page 18: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/18.jpg)
Left Scalp, helix of ears
![Page 19: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/19.jpg)
Right scalp, helix of ears
![Page 20: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/20.jpg)
V-shaped area of neck, upper chest
![Page 21: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/21.jpg)
Extensor aspect of both forearms and dorsum of hands including fingers.
![Page 22: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/22.jpg)
Some lesions are small and coalesced to form a large plaques.
![Page 23: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/23.jpg)
upper back and anterior aspect of right leg
![Page 24: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/24.jpg)
Multiple depigmented lesions with atrophy and scarring
![Page 25: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/25.jpg)
• Mucous membranes
• Oral : normal
• Genital : normal
• Conjunctiva : normal
• Hair and nails : normal
• Palms and soles : normal
![Page 26: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/26.jpg)
Nails - normal
![Page 27: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/27.jpg)
Provisional diagnosis Discoid Lupus Erythematosus (DLE)
Differential diagnosis
Systemic Lupus Erythematosus (SLE)
Sub Acute Cutaneous Lupus Erythematosus (SCLE)
![Page 28: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/28.jpg)
Management
![Page 29: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/29.jpg)
Complete blood picture• Haemoglobin – 12gr%• Total count- 4,000 /cu.mm• Neutrophils – 55 %• Lymphocytes – 40%• Eosinophils – 03%• Monocytes- 02%• Basophils - 0%• Platelets – 1.5lakhs/cu.mmPeripheral Smear: Normocytic / Normochromic.ESR – 80mm/1st hr
![Page 30: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/30.jpg)
Complete urine examination
• Color – pale yellow• Appearance – clear• Reaction – acidic• Sp. gravity – 1.010• Albumin – trace• Sugar – nil• Bile salts – absent• Bile pigments – negative• Pus cells – 2-4/hpf
![Page 31: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/31.jpg)
• Epitheloid cells – 2-4/hpf
• Red blood cells – nil
• Crystals – nil
• Casts – nil
• Amorphous deposits – absent
• Others – nil
• Random Blood Sugar – 89 mg/dl
![Page 32: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/32.jpg)
Liver function tests• Total bilurubin – 0.52mg/dl• Direct bilurubin – 0.23mg/dl• AST(SGOT) -22 IU/L• ALT(10) – 10 IU/L• Alkaline phosphatase – 104 IU/L• Total proteins – 7.6gr/dl• Albumin – 3.7gr/dl• A/G ratio 0.95
![Page 33: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/33.jpg)
Renal function tests
• Urea – 15 mg/dl
• Creatine – 0.7 mg/dl
• Uric acid – 3.7 mg/dl
• Calcium – 9.2 mg/dl
• Phosphorous – 3.5 mg/dl
• Sodium – 139 mmol/L
• Potassium – 3.8 mmol/L
• Chloride – 102mmol/L
![Page 34: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/34.jpg)
• ECG – normal sinus rhythm.
• Chest X –ray - no abnormalities are detected.
• L E cell test – negative.
• Skin Biopsy : 4x4mm punch biopsy was taken from right hand.
histopathology features are compatible with Discoid Lupus Erythematosus (DLE)
• ANA – negative.
![Page 35: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/35.jpg)
Final Diagnosis
Disseminated Discoid Lupus Erythematosus (DLE)
![Page 36: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/36.jpg)
Treatment
Photoprotection: Broad spectrum Sunscreens with SPF-30
applied 30 minutes before sun exposure 3-4 times daily.
Topical therapy: Mometasone furoate cream 0.1% twice daily
on face. Halobetasol propionate cream 0.05% twice
daily on trunk, hands, legs.
![Page 37: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/37.jpg)
Oral :
Tab Hydroxychloroquine 200mg oral BD
(after fundoscopic examination and clearance given by ophtholmology dept)
Tab levocetrizine 5mg oral OD
![Page 38: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/38.jpg)
Before 1 month after follow up
![Page 39: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/39.jpg)
Follow up Treatment
• Broad spectrum Sunscreens.
• Mometasone furoate cream 0.1% once daily on face.
• Halobetasol propionate cream 0.05% once daily on trunk, hands, legs.
• Tab Hydroxychloroquine 200mg oral BD.
• Follow up OP appoinment in 1 month.
![Page 40: Dr Rammohan Reddy 1 year PG, Dept of DVL, Kamineni ... - · PDF fileKamineni Institute of Medical Sciences, Narketpally. •Name : XXX •Age : 33 years •Sex : Female •Occupation](https://reader031.fdocuments.in/reader031/viewer/2022022421/5a857ade7f8b9a14748c1fc8/html5/thumbnails/40.jpg)
Thank you