FOLLOW UP CASE OF SLE ? IATROGENIC CUSHINGS
18year old girl came with chief complaints of fever since 2months back c/o joints pain since 2months back
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18year old girl came with chief complaints of fever since 2months back
c/o joints pain since 2months back
c/o vomitings since 2months back for 1week,
c/o headache along with fever episodes since 2months
c/o pain abdomen since 5days back
HOPI :-
Patient was apparently asymptomatic 2months back ,then she developed fever following after fever subsides pt started having pain in the small joints PIP,DIP,MCP etc.subsides with medication and relapse after stopping the medication.now she has h/o fever a/w multiple joints pains (small joints of hands ---->elbow---->sho byulder).
Patient had h/o migratory polyarthritis.
H/o dragging type of pain in my the both lower limbs (Ankle jnt& joints of foot are spared).
H/o decreased appetite since 2months .H/o pain abdomen (spasmodic type) since 5days back now subsides not associated with loose stools.
H/o vomitings since 2-3days ,non bilious,non projectile containing food particles.
H/o headache present , burning sensation in the eyes
PAST HISTORY
N/K/C/O DM,HTN ASTHMA, THYROID,TB
PERSONAL HISTORY:-
Appetite -decreased since 2months
Diet:-mixed
Bowel & bladder-regular
O/E:
Pallor +
No Icterus/cyanosis/clubbing/Generalized lymphadenopathy/pedal edema
Temp-afebrile
PR- 83bpm
RR-18/min
BP-110/60 mmhg
Spo2- 98%at RA
GRBS-120 mg/dl
CVS- S1 S2 +,No murmurs
RS- BAE+,nvbs +
P/A- soft, non tender
CNS- NAD
X ray of hands
USG
ECG
Other
Serum LDH
PROVISIONAL DIAGNOSIS:-
FEVER WITH POLYARTHRITIS (SECONDARY TO RA? OR SLE?) UNDER EVALUATION
TREATMENT;-
1)T. ULTRACET (325MG+37.5MG) PO/QID
2)T.ZOFER (MD) 4MG PO/SOS
3)T.ZINCOVIT PO/BD
4)T.LIMCEE PO/BD
5)T.PAN 40 MG PO/OD
SLICC criteria for SLE:-
14/02/22
S - C/o fever spikes . (102 recorded morning) . After that no spike
C/o - Multiple joint pains and left elbow mild swelling.
C/o loss of appetite and nausea.
C/o Erythematous rash on malar prominence and nasal bridge .
H/o vomitings and nausea after discharge on 7/2/22 - could be due to HCQ intolerance.
She used T. Onmacortil 10 mg for 2-3 days and stopped later due to vomitings.
HCQ, Aceclofenac stopped on 11/2/22.
C/o fever spikes since yesterday and joint pains .
Hemogram repeat today -
Hb -7.2 ; Tlc - 4,880 ,plt -8,000
Cue - no proteinuria
s. creat -0.9 mg/dl
Cxr - No pleural effusion
Crp - Positive .
plan - to send dengue profile .
Pt vitals stable currently and no bleeding manifestations
Oral ulcer:-
Malar rash
Investigation:-
Diag -
SLE Flare ./ ? Viral pyrexia
Ana + ; Anti- ds DNA + ; Coombs -+
Fever and polyarthralgia
Anemia and severe thrombocytopenia.(? Immune destruction) .
Query - Is this sle flare or secondary infection ?
General dictum if crp is positive - consider infections also.
Crp - negative - Treat as flare
Treatment given :
1) Tab . Dolo 650 mg QID
2) INJ DEXA 2MG IV BD
3) Tab . Pan 40 od
4) Tab zofer 4 mg tid .
5) IVF - NS/RL .
The sensitivity and specificity of platelet autoantibody testing in immune thrombocytopenia: a systematic review and meta-analysis of a diagnostic test
The sensitivity of platelet autoantibody testing is low (53%). The specificity is high (> 90%).
https://onlinelibrary.wiley.com/doi/10.1111/jth.14419
The sensitivity of antiplatelet antibody in SLE patients with ITP is very low so that's the reason why we don't go for it usually
AMC 7
Day 4
S - No fever spike
No episode of vomiting and diarrhoea
C/o polyarthralgia decreased
O:-
O/E
Pt c/c/c
Pallor+
No icterus, cyanosis clubbing, lymphadenopathy, oedema
Temp;-96.8°F
Bp:-110/70mmhg
PR:-68bpm
RR:-16cpm
Hemogram repeat today -
Hb -7.3 ; Tlc - 16,600 ,plt -48,000.
14/2/22
Hb -8.2
Tlc-4,500
Plt-8,000
15/2/22
Hb-8.7
Tlc-4,800
Plt-5,000
16/2/22
Hb-7.3
Tlc-12,550
Plt-25,000
17/2/22
Hb-7.3
Tlc-16,600
Plt-48,000
Pt vitals stable currently and no bleeding manifestations .
A:-
SLE Flare .
Ana + ; Anti- ds DNA + ; Coombs -+
Fever and polyarthralgia
Anemia and severe thrombocytopenia.(? Immune destruction) .
P:
1)Inj.Methyl prednisolone 1g /iv/stat after faculty consultation
2) Tab . Pan 40 mg po/od
3) Tab zofer 4 mg /sos
4) IVF - NS/RL .
AMC 7
Day 5
S - No fever spike
No episode of vomiting and diarrhoea
C/o polyarthralgia decreased
O:-
O/E
Pt c/c/c
Pallor+
No icterus, cyanosis clubbing, lymphadenopathy, oedema
Temp;-97.4°F
Bp:-110/70mmhg
PR:-72bpm
RR:-18cpm
Hemogram repeat today -
Hb -7.3 ; Tlc - 16,600 ,plt -48,000.
14/2/22
Hb -8.2
Tlc-4,500
Plt-8,000
15/2/22
Hb-8.7
Tlc-4,800
Plt-5,000
16/2/22
Hb-7.3
Tlc-12,550
Plt-25,000
17/2/22
Hb-7.3
Tlc-16,600
Plt-48,000
18/2/22
Hb-7.4
Tlc-15,800
Plt-66,000
A:-
SLE Flare .
Ana + ; Anti- ds DNA + ; Coombs -+
Fever and polyarthralgia
Anemia and severe thrombocytopenia.(? Immune destruction) .
P:
1)Inj.Methyl prednisolone 1g /iv/stat
2) Tab . Pan 40 mg po/od
3) Tab zofer 4 mg/sos
4) IVF - NS/RL .
This case report was done by anusha
Thanks for sharing the elog link
26/12/22
Now on presentation; pt has complaints of reddish discolouration ( striae ) over lower abdomen since 3 months and in axilla — purple striae over abdomen since 3 months and in axilla since 1 week ; they are initially small & vertical they slowly progressed to present size ; not associated with itching, bleeding, non scaling
CLINICAL IMAGES
27/12/22
Unit 5
Dr Akash, intern
Dr Hyndavi, intern
Dr Himaja, PGY1
Dr Deepika , PGY2
Dr Vinay , PGY3
Dr Abhinaya , SR
AMC DAY 2
Cubical bed - 2
19 yr/ F
S:
No fresh complaints
O :
Pt is
conscious,coherent,cooperative
BP - 110/70 mm Hg
PR - 84 bpm
Temp - 97.6 F
Grbs - 93 mg/dl
Spo2 - 98 % @ RA
CVS - s1, s2 +
Jvp not raised
RS - BAE +
NVBS HEARD
P/A - soft,nontender
Purple striae +
CNS - NFND
A :
K/C/O SLE since 1 yr with ? Iatrogenic Cushings
Rx:
Monitor vitals BP, Temp, GRBS charting
28/12/22
Unit 5
Dr Akash, intern
Dr Hyndavi, intern
Dr Himaja, PGY1
Dr Deepika , PGY2
Dr Vinay , PGY3
Dr Abhinaya , SR
AMC DAY 3
Cubical bed - 2
19 yr/ F
S:
No fresh complaints
O :
Pt is
conscious,coherent,cooperative
BP - 110/70 mm Hg
PR - 85 bpm
Temp - 97. 8 F
Grbs - 86 mg/dl
Spo2 - 98 % @ RA
CVS - s1, s2 +
Jvp not raised
RS - BAE +
NVBS HEARD
P/A - soft,nontender
Purple striae +
CNS - NFND
A :
K/C/O SLE since 1 yr with ? Iatrogenic Cushings
Rx:
Monitor vitals BP, Temp, GRBS charting
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