A 17 years old Male pt , who is a student, resident at nalgonda presented with the chief complaints of increased itchy red lesions over the body
Chief complaints:
1 . 1 and 1/2 year ago - itchy ring lesions over arm abdomen, thighs,groin region was absorbed
2 . 1 year ago - purple stretch marks all over abdomen, lower back ,upper limb things are absorbed
3 . 6 months ago - facial puffiness , abdominal distension are absorbed
4 . 3 months ago - pedal edema , low back ache , weight gain and decreased libido
5 . 2 months ago - loss of libido , erectile dysfunction
6 . Recently.. feeling low , not feeling to talk to anyone
History of present illness :
A Pt was aparently asymptomatic 1 and 1/2 year back then after eating some non-vegetarian food , he slowly developed erythrmatous round lesions
Shape is annular , itchy all over abdomen , upper limb , groin , inner thigh region
B then they went to a local RMP where he suggested ayurvedic medication and other creams , pt used them for 2 months and lesions reduced abit
C after 2 months , he developed multiple hyper pigmented plaques over Lowe limbs, abdomen
D. He visited to same place and used ayurvedic oils over lesions , used clobetasol ointment for 1yr over lesions
E . 1 year back he noticed pink striae over abdomen then on back , arms
Gradually increased in size
F . Then he visited hospital and used medications (ointment = miconazole and luliconazole ) , clobetasol also used
G . Then abdominal distension and facial puffiness, wt gain was absorbed , but the didn't vist the hospital
H . Since 3 months, pedal edema and low back ache was absorbed , consulted a doctor who suggested monteleukast, luliconqzole ointment for tenia corporis
I . 1 month ago , he stopped medication and visited opd with complaints of
Pink striae , easy fatigue , weakness , low back ache
J . His brother also complainted that , he is being moody , feeling low, not going out , and not interacting with others
Negative history :
No chest pain , no sob , no palpitations
No h/o Decreased urine
No DM , Asthama
Past history:
No similar past history is known
6 months back.. after using medication.. he developed HYPERTENSION
Personal history :
Diet: since 8 months he eats only veg diet... before he had a mixed diet
Sleep : not adequate
Bowel and bladder moments : normal
Food allergy :
Allergic to spinach, fish and other non vegetarian foods. . Eggs
No addictions
Family history :
No similar complaints are absorbed
No history of DM ,HTN is absorbed in family
General examination:
O/E : Pt was c/c/c
BP - 160/100 mmHg
Pr - 96 BPM ,regular ,normovolemic .
Rr - 18/min
Spo2- 98% on ra.
Weight - 63 kg.
Height - 175 cm.
NO pallor ,icterus ,cyanosis , clubbing, lymphadenopathy.
Pedal edema present - pitting type extending upto knee.
Abdominal distension present.
Moon face present
Pink striae noted over anterior abdominal wall and on low back and on upper arms and thighs.
Thin skin present .
Poor healing noticed over leg ulcers and easy bruising noted .
Acne present over face .
Acanthosis nigrans noted over neck.
GYNECOMASTIA PRESENT .
neck pad of fat present .
Sparse scalp hair .
.systemic examination:
Skin examination - Multiple itchy erythematous annular leisons noted all over abdomen , upper limb ,groin and inner thigh region .
Multiple hyperpigmented plaques noted over bilateral lower limbs .
SYSTEMIC EXAMINATION :
CVS - S1S2 heard .No murmurs
RS - BAE present .
No adventitious sounds .
P/A - Soft , distended .
No organomegaly .
Bowel sounds present .
CNS - HMF - INTACT R. L
MOTOR SYSTEM - POWER - UL 5/5 5/5
LL 5/5 5/5
Proximal muscles lower limb - power is 4/5 .
TONE - NORMAL.
REFLEXES - B. T. S. K. A. P
R. +2 +2. +1. +2. +1. FELXOR
L. +2. +2. +2. +2. +1. FLEXOR.
CRANIAL NERVES - NORMAL .
Difficulty in getting up from chair was noticed.
PROVISIONAL DIAGNOSIS -
? IATROGENIC CUSHINGS SYNDROME .
TINEA CORPORIS .
DENOVO HTN .
INVESTIGATIONS :
CBP - HB - 13.4 g/dl
TLC - 6,800
PLT - 1.5 lakhs.
RBS - 139 mg/dl
CUE - ALBUMIN - +1
SUGARS - NIL .
PUS CELLS - 3-4
RBC - NIL .
LFT - TB -1.03
DB-0.21
ALBUMIN - 3.9
RFT - UREA - 22
SERUM CREATININE -0.6
ELECTROLYTES - NA - 136
K- 4
CL-98
USG ABDOMEN - NORMAL.
ECG - SINUS TACHYCARDIA
LVH PRESENT.
On December 1st 2021 :
1 yr back , when striae started
28/5/21
2nd follow up
1st follow up
Investigations
