20 yr old female with ERYTHEMA NODOSUM LEPROSUM (ENL)

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

A 20 yr old female who is a student came with c/o. painful skin lesions over both UL & LL and trunk since 2 yrs (on -off),
H/o nodules on UL & LL with 
H/o fever + associated with joint pains, pedal edema , breathlessness 

The lesions initially started as erythematous papules and later progressed to hyperpigmented plaques within 3 days

K/c/o leprosy diagnosed in govt. hospital taken MB-MDT 11 months prior to onset of present skin lesions
Pt was video counselled for tab.thalidomide 100mg bd on 03/09/21 & on irregular follow up (multiple times & tapered on lesions subsiding on & off)
Slit skin smear done on 03/09/21:(report missed)
Slit skin smear done on 06/11/21: 
AFB--3+
BI--3
MI--60%
Advised to restart MB-MDT & tapered tab.thalidomide 50mg alternate day × 2 weeks 

No significant family history
No other comorbidities 


O/E: pt is c/c/c
Icterus+
No pallor,clubbing, cyanosis, genaralised Lymphadenopathy, pedal edema

Vitals: 
Temp:98.2F
Bp:100/70 mmhg 
Pr: 82bpm
Rr:18 cpm

Generalized xerosis with hyperpigmentation noted all over the body & face

Systemic examination:
Cvs: S1S2 heard
Rs:BAE+,NVBS heard
P/A: soft,non tender,bs+
Cns: NFD

Provisional diagnosis:
F/u/c  Erythema Nodosum Leprosum(ENL)

TREATMENT:
1.continue MB-MDT
2.Tab.THALIDOMIDE 50 mg alternate days


Comments

Post a Comment

Popular posts from this blog

60 YR OLD MALE CAME WITH C/O ABDOMEN DISTENSION SINCE 20-30 DAYS, PAIN ABDOMEN SINCE 1 WEEK, CONSTIPATION SINCE 2 DAYS, DECREASED URINE OUTPUT SINCE 2 DAYS

Image
It 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 60 YR OLD MALE CAME WITH C/O ABDOMEN DISTENSION SINCE 20-30 DAYS, PAIN ABDOMEN SINCE 1 WEEK, CONSTIPATION SINCE 2 DAYS, DECREASED URINE OUTPUT SINCE 2 DAYS PATIENT WAS APPARENTLY NORMAL 1 MONTH BACK THEN HE DEVELOPED ABDOMINAL DISTENSION WHICH IS PROGRESSIVE AND ASSOCIATED WITH PAIN ABDOMEN SINCE 1 WEEK, CONSTIPATION ANS DECREASED URINE OUTPUT SINCE 2 DAYS NOT A K/C/O HTN,DM,CAD,ASTHMA,TB H/O TRAUMA TO LEFT LEG 5 YR BACK OCCASIONALLY TAKES ALCOHOL GUTKA CHEWER NON SMOKER HIS APPE
Read more

given a case of 42yr old female with multiple health events

I've 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 come up with a diagnosis and treatment plan.  You can find the entire real patient clinical problem in this link here.. https://classworkdecjan.blogspot.com/2019/05/42-f-with-severe-regular-edema-with_17.html?m=1 Following is my analysis of this patient's problem: The problems I found are 1.frequent falls to left(left limb and foot gave out) 2.migraine with aura and cognitive impairment 3.breathing difficulty  4.swelling mainly over abdomen and face 5..salt craving 6.reduced urination and reduced sweating 7.decreased exercise intolerance 8.sleep disturbances 9.increased tolerance to pain Others:-rash on face              -PCOS              -Bipolar disorder,anxiety,depression Presently having:oral ulcers and vaginal ulcers Reasons for  ▪︎
Read more

52yr old male with involuntary movements of hand and itchy skin lesions

Image
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 is welcome." Case:(22/10/2021) A 52year old male resident of bhogramguri of westbengal came to the casualty with chief complaints of involuntary movement of fingers since 6months(during resting),gradual onset,non progressive. Itching over the scalp,brows,armpits since 12yrs. Discoloration over the neck and shoulder since 12yrs , Decreased vision in both eyes since 6months(gradually progressive),  ringing sensation in the ear since 3years(on/off) No h/o. Giddiness PAST HISTORY:
Read more