Final practical examination - short case

 February 4 2022.

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30 years old female came to the causality with the chief complaints of painful lesions along the body since 1 year.

HISTORY OF PRESENT ILLNESS;

Patient was apparently asymptomatic 1 year back.

Then she initially felt pain over the left leg following she noticed reddish discoloration with small nodular lesions,these nodules are painful associated with burning sensation ,they progressively grown and  their is local rise in temperature in that nodular area and  after some days healed with hyper pigmented rashes.

Initially she used Ayurvedic medicine for 6 months even then the lesions didn't subside

6 months back she noticed similar type of non - itchy lesions over both hands extended proximally and healed with hyper pigmented rashes.

PAST HISTORY;

-She developed similar type of lesions on ears and face 2 months back,currently these lesions are not healed.

-not a known case of DM,TB, HTN ,Asthma

PERSONAL HISTORY; 

Diet - mixed

Sleep - adequate

Bowel and bladder movements  - Normal

No addictions

FAMILY HISTORY;

No relevant family history.

PHYSICAL EXAMINATION;

No pallor

No Icterus cyanosis clubbing lymphadenopathy oedema

VITALS;

Temperature - a febrile

BP-130/80 mm Hg

PR- 82 bpm

RR- 18 cpm 

SPO2- 98 on RA

SYSTEMIC EXAMINATION;

CVS - s1 s2 heard,no murmurs.

RS- BAE+

P/A - soft nontender

CNS

Patient is conscious

Speech - Normal.

Investigations;

ECG;

Hemogram

Hb- 10.1 gm/dl

Lymphocytes - 13%

PCV -31.2 vol %

MCV - 76.5 fl

MCH - 24.8 pg

RBC - 4.8 millions/cumm

LFT;

Total bilirubin - 0.54 mg / dl

Alkaline phosphate - 254IU/L

Complete urine examination;

PROVISIONAL DIAGNOSIS;

ERYTHEMA NODOSOM LEPROSUM

(Cutaneous Vasculitis)

Treatment;

Thalidomide