1801006062 CASE PRESENTATION
LONG CASE :
CHIEF COMPLAINTS:
A 40 year old female resident of suryapet came to the OPD with chief complaints of generalised weakness and generalised body pains and unable to walk since 6 months
HISTORY OF PRESENT ILLNESS :
Patient is apparently asymptomatic 3 years ago then in 2019 she developed weakness in left lower limb which is sudden in onset and gradually progressive for which she consulted a local doctor and found to have low levels of potassium and have been supplemented with potassium then the attack was subsided.
Sequence of illness after the first episode :
In November 2021 :
History of severe episode of upper limb and lower limb weakness , loss of consciousness for 2 days and loss of speech for 2 days and she also has history of bowel movements and again diagnosed as hypokalaemia and treated with potassium supplements and kept on ventilation and blood transfusion (1 unit ) is done and discharged after 5 days
on may 2022 :
She has similar complaints as past but which is less severe and she is able to walk and she is conscious and again treated for hypokalaemia and discharged in 3 days
February 2023 :
Similar complaints as past and presented with 2 episodes of vomitings which are non bilious , non projectile and food particles as content
During which she noticed a left sided parotid swelling and referred to dental department and the swelling got subsided in 2 days and she complained of dryness of mouth so they took lower lip biopsy then later she developed dryness of eyes with burning sensation and dry skin with no itching.
March 2023 :
She came for follow up and referred to ophthalmology and orthopaedic department and further treatment is given .
Present complaints :
Body pains , stiffness and difficulty in walking and difficulty in getting up from the bed and needs support .
No H/o fever , cough , tingling , numbness , discolouration of skin, dental caries.
PAST HISTORY :
Not a known case of hypertension, Diabetes , TB , asthma , epilepsy , coronary artery disease .
TREATMENT HISTORY:
She was on anti rheumatoid drugs for 3 years
On Potassium syrup from 3 years (POTKLOR)
FAMILY HISTORY :
No significant family history
PERSONAL HISTORY :
She was a daily wage labourer but she stopped working since 3 years due to her illness .
Appetite: normal
Diet : mixed
Bowel and bladder : regular
Sleep : adequate
Addictions : no addictions
GENERAL PHYSICAL EXAMINATION :
Patient is conscious, coherent, cooperative and well oriented to time , place and person
Moderately built and nourished
No signs of pallor , icterus , cyanosis ,clubbing , edema , generalised lymphadenopathy.
VITALS:
Temperature: afebrile
Blood pressure :110/70 mmhg
Pulse rate : 88 bpm
Respiratory rate : 17cpm
GAIT VIDEO :
https://youtube.com/shorts/V1NxKaQvXns?feature=share
SYSTEMIC EXAMINATION:
CVS :
No visible pulsations, scars, engorged veins.
No rise in jvp
Apex beat is felt at 5 Intercostal space medial to mid clavicular line.
S1 S2 heard . No murmurs.
RESPIRATORY SYSTEM:
Shape of chest is elliptical, b/l symmetrical.
Trachea is central. Expansion of chest is symmetrical
Bilateral Airway Entry - positive
Normal vesicular breath sounds
CNS:
Sensory system - intact
Motor system - intact
No focal neurological deficits
PER ABDOMEN :
On inspection - abdomen is flat & symmetrical
Umbilicus is central and inverted
No scars, sinuses & engorged veins seen.
All 9 regions of abdomen are equally moving with respiration
On palpation - abdomen is soft and non tender
On percussion - no shifting dullness, no fluid thrill
On auscultation - normal bowel sounds are heard
PROVISIONAL DIAGNOSIS:
Sjögren’s syndrome with
Rheumatoid arthritis
Recurrent hypokalaemic paralysis secondary to distal renal tubular acidosis
INVESTIGATIONS :
- February 1 st 2023
Serum electrolytes
Sodium:142 mmol / lit
Potassium: 1.8 mmol/lit
Chloride:108 mmol/ lit
Serum calcium:9.8 mg / dl
Serum creatinine:1.3 mg/ dl
Blood urea:29 mg / dl
Urinary calcium:3.0 mg/day
Spot urine sodium:60
Spot urinary potassium:12.0
- March 13 th 2023
Hb:9.6g/dl
ESR:30mm/hr
Serum creatinine:1.1mg/dl
Serum potassium:4mmol/L
SGOT:23IU/L
SGPT:16IU/L
- March 15 th 2023
ESR:36mm/hr
Serum sodium:139mmol/L
Serum potassium:3.06mmol/L
Serum chloride:114mmol/L
Complement C3:114mg/dl (90-180mg/dl normal)
Complement C4 :63mg/dl (10-40 mg/dl normal)
Serum creatinine:0.99mg/dl
SGOT: 15IU/L
SGPT:11IU/L
BIOPSY REPORT :
Histopathological Findings: H and E stained section shows the presence of multiples lobules of minor salivary gland tissue consisting of normal appearing mucous acini with intralobular and interlobar ducts. The salivary gland tissue also shows the presence of multiple foci (25) of lymphocytic infiltrate, endothelial lined blood vessels and hemorrhagic areas Correlating with clinical features, the above histopathological features are suggestive of sjogren’s syndrome
TREATMENT:
Tab NODOSIS
Syrup POTKLOR 15ml po/TID
TAB PREGABA M 75mg po
Tab PANTOP
Tab HCQ 200mg
Tab PREDNISOLONE
45 year old male who is a resident of Nalgonda and Sheperd by occupation presented to the hospital with chief complaints of shortness of breath and cough since 6 years
abdominal distention , facial puffiness , pedal edema since 3 years
patient was apparently asymptomatic 6 year back and then he developed shortness of breath which is insidious in onset gradually progressive which is grade 2 (MMRC grading ) .
Then he developed cough which is productive with sputum which is yellow in colour and non blood stained
There is history of abdominal distention since 3 years which is insidious in onset and gradually progressive then he consulted a local doctor and used medications but then its not relieved and continued to progress for which he came here .
He also has history of facial puffiness and pedal edema for which he is on medications .
History of constipation since 1 year .
No history of vomiting , fever, jaundice , orthopnoea , PND, chest pain , palpitations , weight loss.
DAILY ROUTINE:
He wakes up in the morning by 6'o clock and goes to the work by 9'o clock after having breakfast and he will have his lunch by 1 in the afternoon and continues with the work then he goes back to home by 6 pm in the evening .
PAST HISTORY:
No similar complaints in the past
Not a known case diabetes , hypertension , asthma, TB, epilepsy
He has a H/o liver infection 1year ago which had got relieved with medication.
Treatment history:
Right IOL implantation in 2021
Family history:
Not relevant
Personal history:
Diet : mixed
Appetite-normal
Sleep-inadequate
Bowel and bladder movements-constipation since 1year,urine output is normal
Addictions-He had H/o alcohol intake since his childhood 200ml/day and abstinence of alcohol from 1year
H/o smoking since childhood 18 cigars per day
GENERAL EXAMINATION:
Patient is conscious,coherent,cooperative and well oriented to time and place.
Moderately built and nourished
Pallor: absent
Icterus: absent
Cyanosis: absent
Clubbing: absent
Lymphadenopathy:absent
Pedal edema: B/L pedal edema is present
VITALS :
Bp:130/70 mm/hg
PR:88/min
RR: 17 cpm
Temperature: afebrile
Spo2: 96%
INVESTIGATION :
SAAG:
Serum albumin : 2.1 g/dl
Ascitic albumin : 0.22 g/dl
SAAG: 1.79 g/dl
Ascitic fluid protein sugar :
Comments
Post a Comment