BLOG

CASE OF 32 YR OLD FEMALE WITH BILATERAL DEFORMITIES 

Greetings to one and all who are currently reading my blog.  This is Jasmisri,fifth semester medical student

This is an online E - log book to discuss our patients 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 portfolio and your valuable inputs on the comment box.

CASE:-

A 32 yr old female house wife from janagam came to hospital

CHIEF COMPLAINTS:-

Bilateral deformities of both hands since 1 yr

HISTORY OF PRESENT ILLNESS:-

Patient was apparently asymptomatic 1 year ago she developed pain in right hand follow by ulnar deviation of fingers at second metacarpalophalengeal joint and progressed to 3rd,4th and 5th metacarpalophalengeal joint in a period of 1 month.

She developed pain in the joints : 

bilateral wrists 

bilateral elbow 

Bilateral shoulder joints

Bilateral ankles 

Bilateral knees

No pain in toes

She also developed swelling of her bilateral soles because of which she was unable to walks

She went to a rmp for which she was given some medicine and used during which pain decreased later on when she stopped those medication she again developed pains all over the joint

She used on and off when ever she had pain and stopped when she didn't  and again went to a hospital 10 days back where she again got medication

The 2nd day night after using medication at about 2 am (the next day ) she felt loss of sensation at right hand followed by left limb the neck

She could not lift her head

she did not have shortness of breath during this episode

When taken to a nearby hospital where she was medication and she regained her sensation in first neck then limbs then hand

At the hospital on admission she had hypokalemia and after two days of treatment had hyperkalemia 

she was referred to higher centre for management came here for management

No deformity in wrist joint ,thumb

PAST HISTORY:-

• No similar complaints in the past.
•  No history of DM,HTN,TB,Asthma,Epilepsy.

PERSONAL HISTORY:-

• Mixed diet
• Normal apetite
• Bowel and bladder moments normal
• Sleep adequate
• No addictions

MENSTRUAL HISTORY:-

• Menarche age:-15yrs
• Marital age:-20yrs
• Cycles were regular,3/30 days.
• She gave birth to 3 children by LSCS,No NICU,term 
• 1st child-girl,1.75kg
• 2nd child-girl,2kg
• 3rd child-boy,2 1/2kg

GENERAL EXAMINATION:

• Patient is lean bulit and nourished
• No pallor,icterus,cyanosis,clubbing,edema.

VITALS: 

• Bp:110/70mmHg
• PR:84bpm
• Afebrile

CNS:

• HMF intact
• Motor and sensory functions are intact

CVS:-

• S1 and S2 present
• No murmurs

RESPIRATORY SYSTEM:-

• Chest symmetrical 
• NVBS

ABDOMEN:

• Soft and non tender
• No organomegaly

JOINT EXAMINATION:

• Bilateral 2nd,3rd,4th ,5th MCP of hands showing (ulnar deviation)deformity 
• Thumbs of both hands are spared with no deformity.
• No wrist joint deformity.

Provisional diagnosis:-?AUTO IMMUNE ARTHRITIS.

INVESTIGATIONS:

08/09/22

09/09/22

10/09/22

FINAL DIAGNOSIS:

AUTOIMMUNEARTHRITISWITH HYPOKALEMIA SECONDARY TO ? RENAL TUBULAR ACIDOSIS.

TREATMENT:

1)Inj.Neomol 1gm /IV/SOS

2)Tab.Dolo 650mg/po/TID

3)Bp and temperature monitoring 4th hourly