30 year old with B/L knee pains and fever

CBBLE UDHC SIMILAR CASES 

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box.


A 31year old female, who studied till degree and is a housewife by occupation came with chief complaints of: 
  • B/L knee pains since 2 weeks
  • Fever on and off since 2 weeks
  • Oral ulcers since 6 months 
Patient was apparently asymptomatic 2 years ago and then she developed pain in her right shoulder, which was dull aching type and continuous, for which she went to an Orthopaedic and was given medication. The pain kept alternating between right and left shoulder and sometimes both simultaneously. She experienced tightness of shoulder joints on waking up and needs someone to pull her up from the bed. Her pain was relieved on medication but it kept recurring for 6 months. 
 

Then she developed fever, oral ulcers, redness of eyes and diminished vision, facial puffiness and went to a private hospital. 
On routine investigations, they found that she was losing a lot of proteins in her urine, due to that and her diminishing vision they decided to a kidney biopsy, after which a diagnosis of SLE was made. She was put on Tab. OMNOCORTIL 5 mg for 3 days and steroid injections. 

After 6 months, steroids were stopped and was started on Tab. MFM for 4 months (2 tab at 8 AM and 1 tab at 8 PM), which she used and stopped after one month.  

She developed oral ulcers, hair loss, proximal interphalangeal pain of both hands in January 2022. 
Her  proximal interphalangeal joint pain   
in right and left hands, is associated with stiffness especially in the morning. 

In 2014 Dec, when she was 24 years she wa a married. 
In 2015, her first pregnancy reached full term and NVD was done. 

In 2018, her second pregnancy, she suffered an abortion in the 4th month. On investigation, she was found to be suffering from Hypothyroidism and was started on medication. 

In 2019, her third pregnancy, reached full term and NVD was done. 

Surgical history: 
Cataract surgery of right eye in Jan 2022. 

Treatment history: 
Patient is currently on
  1. Tab. MMF 500mg PO BD (8AM & 8 PM)
  2. Tab. FOLLITRAN 10mg weekly once 
  3. Tab. LIVOGRN PO BD 
  4. TAB. HCQ 200mg OD
  5. Tab. SHELCAL PO OD
  6. Tab. THYRONORM 50mcg

General examination: 

Patient is conscious, coherent and cooperative. 

Vitals on admission: 

Temp: 102°F
BP: 120/80
PR: 110 bpm

CVS: S1 S2 present 
No murmurs or thrills heard 

RS: BAE present, NVBS heard 

CNS: E4V5M6

P/A: soft, non tender 




Rash on her forehead 




Rash on her back 


Ulcer on her lower lip

Ulcers on her gum

Investigations: 

Hemogram: 
Hb: 9.3
TLC: 3500
N/L/E/M: 78/15/2/5
Plt: 2.3

CUE: 
Albumin: trace 
Sugars: nil
Pus cells: 2-3 
Epithelial cells: 2-3 

APTT: 32s
PT: 16s
INR: 1.11

Temperature charting: 









Diagnosis: 

SYSTEMIC LUPUS ERYTHEMATOSUS - CLASS III LUPE NEPHRITIS
WITH ? RHEUMATOID ARTHIRITS 
WITH HYPOTHYROIDISM 
WITH BILATERAL RETINAL VASCULITIS 

TREATMENT: 
  1. IVF NS RL @ 75ml/hr
  2. Inj. NEOMOL 1 gm IV SOS
  3. Tab. DOLO 650mg PO/QID
  4. MUCOPAIN GEL for L/A over ulcers. 

https://caseopinionsbyrollno156.blogspot.com/2022/03/30-year-old-with-bl-knee-pains-and-fever.html

New admission 
30/3/22
ICU 2nd bed 

S: 
B/L knee pains since 2 weeks 
Oral ulcers since 6 months 

O: 
Patient is conscious, coherent and cooperative. 
Temp: 98.3°F
BP: 110/80 mm Hg
PR: 99 bpm

CVS: S1 S2 present 
No murmurs or thrills heard 

RS: BAE present, NVBS heard 

CNS: E4V5M6

P/A: soft, non tender 

Hemogram: 
Hb: 9.3
TLC: 3500
N/L/E/M: 78/15/2/5
Plt: 2.3

CUE: 
Albumin: trace 
Sugars: nil
Pus cells: 2-3 
Epithelial cells: 2-3 

APTT: 32s
PT: 16s
INR: 1.11

A:
SYSTEMIC LUPUS ERYTHEMATOSUS - CLASS III LUPUS NEPHRITIS
WITH ? RHEUMATOID ARTHIRITS 
WITH HYPOTHYROIDISM 
WITH BILATERAL RETINAL VASCULITIS 

P: 
1.IVF NS RL @ 75ml/hr
2.Inj. NEOMOL 1 gm IV SOS
3.Tab. DOLO 650mg PO/QID
4.MUCOPAIN GEL for L/A over ulcers.


Opthalmology referral I/V/O





Comments

Post a Comment

Popular posts from this blog

Medicine Blended Assignment (October)

Image
  I have been given the following cases to solve in an attmept to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and coem up with a treatment plan. This is the link of the questions asked regarding the cases: https://medicinedepartment.blo gspot.com/2020/09/medicine-pap er-for-october-2020-first.html ?m=1 Below are my answers to the Medicine Assignment based on my comprehension of the cases.  First case "57 year old man with jaundice, pedal edema and abdominal distension since three years and bleeding gums since three days" https://swathibogari158. blogspot.com/2020/09/chronic- decompensated-liver-disease. html 1) What is the reason for this patient's ascites?  Ans. This patient has the following features: History  Presenting complaints of Jaundice (icterus seen on sclera) Bilateral Pedal edema (pitting type) extending to...
Read more

Medicine blended assessment

Image
  I have been given this case to solve in an attempt to understand the topic of "Patient Clinical Data Analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis with a treatment plan. You can find the complete case here   https://alekyatummala.blogspot.com/2020/09/45-yr-female-with-anasarca.html?m=1 . CASE:   The presenting complaints in order of priority according to me are: 1. Pedal edema Onset: insidious; on and off from 5 months back and progressive edema since 5 days. Bilateral pedal edema. Pitting type (Renal?Cardiac?Hepatic?Severe Malnutrition?)  Progressive over a course of 1 week. Started in lower limbs and progressed to cause facial puffiness and abdominal distention. (facial puffiness hinting at renal cause? could aso be myxoedema?) Aggravating factors: Walking Relieving factors: on rest. Patient went to a doctor regarding this complaint where she was  asked to redu...
Read more

Active learning of the topic Paraparesis

Hello. We had been given a few cases every week to enhance our competence in the field of medicine and taught to enhance our learning by having active conversations with our peers and teachers. You can find the case details here   https://vaish7.blogspot.com/2020/05/medicine.html?m=1  and my interpretation of the case here  https://caseopinionsbyrollno156.blogspot.com/2020/05/trio-of-paraparesis-cases.html I have borrowed this excerpt from my peer  https://medcases.blogspot.com/2020/05/case-discussion-on-paraparesis-case.html   We were given 3 cases of paraparesis with very different etiologies. But in the journey of reaching the diagnosis we came up with a lot of questions. Here's  a peak [29/05/20, 8:38:56 PM] Student16: 1.WHAT IS THE REASON FOR  Elevated Liver enzymes and reduced Creatinine and Lymphocytes ; Frequent Change of Position recommended to the patient ; Rt sided reflexes being more pronounced than left sided ? Does is have anything t...
Read more