GENERAL MEDICINE CASE DISCUSSION

SUPRIYA GAGIREDDY 42

Hi,I am supriya 5th sem medical student.This is an online elog book to discuss our patients de-identified health data shared after taking his/her/guardians signed informed consent.Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.This E-log book reflects my patient centered online learning portfolia. 

Patient is referred from Dermatology department. 

A 66 year old male patient from Kakkereni, AP Lingotam, Shepherd by occupation came to the OPD with

CHIEF COMPLAINTS:
 Multiple painful blisters all ove the body sparing palms and soles. 

History Of Presenting Illness

Patient was apparently asymptomatic 5 years ago then he started developing itching all over the body suddenly which subsides temporarily on applying Vaseline. 

5 days ago he developed a blister on the dorsal surface of the middle distal phalynx of his left hand following which his body started itching and blisters started appearing on his body starting from the periphery spreading to the trunk which were painful. It was associated with fever but cured immediately on taking medication. The blisters are rupturing spontaneously and serosanguinous fluid is oozing out of the ruptured blister. 

Past history

He had no similar complaints in the past. 

K/c/o Diabetes mellitus since 5 years and Hypertension since 3 years and is on medication with Telmesartan and Metformin respectively. 

Not a k/c/o Tuberculosis, Asthma, Epilepsy, CAD. 

Has a history of allergy to few vegetables like Egg plant, potato. 

Personal history

Diet - Mixed

Appetite - Normal

Sleep - Inadequate due to painful blisters

Bowel and bladder movements - Regular

Addictions - Occasional Alcoholic

Family history - No other family members have similar complaints. 

Drug history - Metformin for Diabetes since 5 years and Telmesartan for Hypertension since 3 years. 



General physical examination

Patient is conscious, coherent and cooperative

Moderately built and moderately nourished

No Pallor, Icterus, Cyanosis, Clubbing, Generalised lymphadenopathy, Pedal edema

Vitals

Temperature - Afebrile

Pulse rare - 76 bpm

Respiratory rate - 18 cpm

Blood pressure - 120/80 bpm

Skin - Multiple bullae and pustules over B/L upper and lower limbs, trunk, buttocks and one on distal phalynx with erosions, crusting and oozing blood and serous fluid. 





Systemic examination

CVS - S1, S2 heard

Respiratory system - BAE present

Abdomen - Soft, Non tender

CNS - No focal neurological deficits. 


Provisional diagnosis 

Bullous Pemphigoid? 


Investigations

Culture and sensitivity of pustule

CBP, FBS, CUE, PLBS, LFT, RFT. 






Treatment

Cap. AMOXICILLIN 625mg BD

FUDIC CREAM BD

Tab. ATARAX 10mg OD

Tab. DOLO 650mg BD 3x days

Inj. HAI premeal SC/TID 

GRBS monitoring

Strict Diabetes control


Differential diagnosis

Bullous Pemphigoid

Bullous Impetigo

Folliculitis + Acute Paronychia

Eczema  with secondary bacterial infection


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