45/F with itchy skin lesions over back, hands, neck and face

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Chief complaints: 

Patient c/o itchy skin lesions over back, hands, neck, face since 3 months. 

C/o fever since 2 months (1episode every day) 

C/o oral ulcers since 1 month 

C/o joint pain since 15 days 

HOPI: 

Patient was apparently normal 3 months back, when her complaints started as itchy skin lesions over back which progressed to hands. 

C/O high grade, continuous fever, 1 episode per day, relieved on taking medication. 

H/o painful oral ulcers since 1 month, associated with difficulty in swallowing and burning sensation. 

C/o joint pains since 15 days associated with swelling 

No h/o morning stiffness.

H/o photosensitivity present.

H/o usage of

- TAB. OMNACORTIL 30MG

- TAB AUGMENTIN 625MG

- BETAMETHASONE LOTION

- CANDID MOUTH PAINT

No occult blood present in stools. 

No h/o new drug intake prior to symptoms 

No h/o dry eyes, mouth, raynauds phenomenon

No h/o chest pain, dysnea, palpitations

Past history:

K/c/o elephatiasis of right leg since 30 years 

N/K/C/O DM2, HTN, CAD, ASTHMA, TB, EPILEPSY, CVD, CAD, THYROID DISORDER 

General Examination :  

Patient is examined in a well lit room after taking informed consent. 

Patient is conscious, coherent and cooperative. 

She is moderately built and moderately nourished. 

Pallor: Present 

Icterus: absent

Cyanosis: absent

Clubbing: absent 

Generalized Lymphadenopathy: Absent

Edema: Absent

Vitals: 

Temp: 97F 

BP: 120/80mmhg 

PR: 84 bpm 

RR: 16 cpm 

GRBS: 98

SYSTEMIC EXAMINATION : 

CVS : S1 S2 heard. No murmurs 

RS : Bilateral air entry present 

CNS : no focal neurological deficit 

P/A : soft non tender

     

Skin: 

O/E: 

Multiple oral ulcers noted over bilateral buccal mucosa, hard palate

Multiple polysized hyperpigmentated plaques with crusting noted over face, neck, hands, back, abdomen. 

Diffuse loss of hair over scalp

Non pitting edema of right lower limb 

Multiple polysized hyperpigmentated macules noted over bilateral cheeks, forehead.

ECG: 

29/05/23 

30/05/23: 

31/05/23

01/06/23

02/06/23

 

X-ray spine:

Impression: 

Mild degenerative changes notes in the cervical spine. 

Ophthal referral: 

On fundus examination, no changes of hypertensive retinopathy, noted in both eyes. .

Gastroenterology Referral: 

Esophageal candidiasis

2D echo: 

Treatment: 

1. TESS PASTE L/A TID (20MIN BEFORE FOOD) 

2. TAB. TECZINE 10MG OD 

3. SUNCROS AQUAGEL L/A SPF 50 TID 

4. TAB. ZINCOVIT OD 

5. FUDIC CREAM L/A BD 

6. TAB. PREDNISOLONE 20MG OD 

7. TAB. PAN 40MG OD (BBF) 

8. TAB. TELMA 40MG PO/OD AT 8AM