65Y MAN WITH ABDOMINAL DISTENSION
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Here is a case that I have seen:
GM unit 3 admission on 03/03/2021
Unit 3:
Interns:
Dr. Harsha
Dr. Leela sai sreeja
Dr. Archana
Dr. Kalyan
Dr. Jeeharika
Dr. Raveen PGY1
Dr. K.Vaishnavi PGY2
Dr. Aravind PGY3
Dr. Vamshi PGY3
Dr.Hareen SR
Dr.Praveen Naik Ass.Prof
Dr.Rakesh Biswas HOD
A 65 year old farmer by occupation came with Complaints of
SOB since 10 days (worsening)grade 3.
H/o fever since 2 days(on and off)
Decreased urine output since 3 days.
Patient was apparently asymptomatic 10 years back then he developed pain,dragging type of sensation in right upper limb and was prescribed pain killers and steroids which he used for 2 years and later developed hemetemesis for which he came to kamineni and stayed for 2 days and was referred to osmania general hospital (passing large clot of blood ) and stayed there for a month ( blood transfusions were done) and was discharged and used medication for once a week and stopped and no usage of painkillers and steroids for 4 years
Later he had an RTA( fall from the cart) and sustained injuries and started using steroids for the past 3 years..
H/O pedal edema and abdominal distension his previous recall of events dates back to 1year where it is progressive and subsided on and off by medication and presented to OPD as it is worsening from 10days
H/O SOB since 3months worsening from 10days,ocassional palpitations present 3months back he was doing is usual and suddenly developed Grade4 SOB and using medicaiton on and off.
2months back he had a history of trauma and wound was neglected and he continued his work going regular field work.
As discharing was increased from wound, he underwent dressings at a local clinic and also came to KIMS on 21/1/21 ,where cultures we're send and pseudomonas was isolated and didn't take any medication
Fever since 2months On and off no diurnal variation with ocassional chills and subsiding on antipyretics.
H/O decrease urine output since 3-4 days and he was doing is usual before 4-5 times per day associated with nocturnal enuresis,denies h/o burning and tingling sensation of feet
In his words
He said he stamped on broken bangles with his right leg in order to remove that ( as it was pierced) he rubbed his sole of the foot to the leg and suffered and injury in the posterior aspect of leg
He also told it was bleeding at that time
Timely he had dressing done and done the field work ( muddy waters) for more than a week
As it was not subsiding with pain and discharge
He came to kamineni got the dressings done and culture was isolated to be pseudomanas and discontinued medication after around a week
History of
Polyarthris since 10 years
Joints involved were
PIP
Wrist joint
Elbow
Shoulder
Knee and
Ankle joint
It was on and off as he mentioned there was no pain and didn’t use medication for 4-5 years
General examination:
Patient was conscious coherent cooperative
Vitals:
Afebrile to touch
PR-88bpm
RR-18cpm
BP-140/90 mmHg
SPo2-99%@ room air
GRBS-102mg/dl
CVS:S1 S2 +
R/S: BAE+ Clear
CNS: NAD
P/A : Soft, distended
No local rise of temperature
No tenderness
Umbilicus:transverse slit like
All quadrants moving equally with respiration
No visible scars,sinuses
Multiple rashes present all over abdomen
Skin is dry, coarse,scaly
Lab investigations:
Diagnosis:
?Cushing syndrome secondary to iatrogenic steroid abuse
12/3/21
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